Phosphonate compounds for treatment of medical disorders

ABSTRACT

Compounds, methods of use, and processes for making inhibitors of complement Factor D comprising Formula I, or a pharmaceutically acceptable salt or composition thereof wherein R 12  or R 13  on the A group is a phosphonate substituent (R 32 ) are provided. The inhibitors described herein target Factor D and inhibit or regulate the complement cascade. The inhibitors of Factor D described herein reduces the excessive activation of complement.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of provisional U.S. Application No. 62/210,007, filed Aug. 26, 2015 and the entirety of the application is hereby incorporated by reference for all purposes.

BACKGROUND

An immune disorder occurs when the immune system is not performing in a normal manner. Inflammation is a protective response that involves the immune system, blood vessels, and molecular mediators. A wide variety of medical disorders are caused by detrimental immune or inflammatory responses, or the inability of a cell to respond to a normal immune or inflammatory process.

The complement system is a part of the innate immune system which does not adapt to changes over the course of the host's life, but instead is recruited and used by the adaptive immune system. For example, it assists, or complements, the ability of antibodies and phagocytic cells to clear pathogens. This sophisticated regulatory pathway allows rapid reaction to pathogenic organisms while protecting host cells from destruction. Over thirty proteins and protein fragments make up the complement system. These proteins act through opsonization (enhancing phagocytosis of antigens), chemotaxis (attracting macrophages and neutrophils), cell lysis (rupturing membranes of foreign cells) and agglutination (clustering and binding of pathogens together).

The complement system has three pathways: classical, alternative and lectin. Complement Factor D plays an early and central role in activation of the alternative pathway of the complement cascade. Activation of the alternative complement pathway is initiated by spontaneous hydrolysis of a thioester bond within C3 to produce C3(H₂O), which associates with Factor B to form the C3(H₂O)B complex. Complement Factor D acts to cleave Factor B within the C3(H₂O)B complex to form Ba and Bb. The Bb fragment remains associated with C3(H₂O) to form the alternative pathway C3 convertase C3(H₂O)Bb. Additionally, C3b generated by any of the C3 convertases also associates with Factor B to form C3bB, which Factor D cleaves to generate the later stage alternative pathway C3 convertase C3bBb. This latter form of the alternative pathway C3 convertase may provide important downstream amplification within all three of the defined complement pathways, leading ultimately to the recruitment and assembly of additional factors in the complement cascade pathway, including the cleavage of C5 to C5a and C5b. C5b acts in the assembly of factors C6, C7, C8, and C9 into the membrane attack complex, which can destroy pathogenic cells by lysing the cell.

The dysfunction of or excessive activation of complement has been linked to certain autoimmune, inflammatory, and neurodegenerative diseases, as well as ischemia-reperfusion injury and cancer. For example, activation of the alternative pathway of the complement cascade contributes to the production of C3a and C5a, both potent anaphylatoxins, which also have roles in a number of inflammatory disorders. Therefore, in some instances, it is desirable to decrease the response of the complement pathway, including the alternative complement pathway. Some examples of disorders mediated by the complement pathway include age-related macular degeneration (AMD), paroxysmal nocturnal hemoglobinuria (PNH), multiple sclerosis, and rheumatoid arthritis.

Age-related macular degeneration (AMD) is a leading cause of vision loss in industrialized countries. Based on a number of genetic studies, there is evidence of the link between the complement cascade and macular degeneration. Individuals with mutations in the gene encoding complement Factor H have a fivefold increased risk of macular degeneration and individuals with mutations in other complement factor genes also have an increased risk of AMD. Individuals with mutant Factor H also have increased levels of C-reactive protein, a marker of inflammation. Without adequate functioning of Factor H, the alternative pathway of the complement cascade is overly activated leading to cellular damage. Inhibition of the alternative pathway under these circumstances is thus desired.

Paroxysmal nocturnal hemoglobinuria (PNH) is a non-malignant, hematological disorder characterized by the expansion of hematopoietic stem cells and progeny mature blood cells which are deficient in some surface proteins. PNH erythrocytes are not capable of modulating their surface complement activation, which leads to the typical hallmark of PNH—the chronic activation of complement mediated intravascular anemia. Alexion Pharmaceutical's anti-C5 antibody eculizumab (Soliris®) is currently the only complement-specific antibody on the market, and is the first and only approved treatment for paroxysmal nocturnal hemoglobinuria (PNH). Exciluzimab is also approved for atypical hemolytic uremic syndrome (aHUS). However, many of the patients treated with eculizumab remain anemic, and many patients continue to require blood transfusions. In addition, treatment with eculizumab requires life-long intravenous injections. Thus, there is an unmet need to develop novel inhibitors of the complement pathway.

Other disorders that have been linked to the complement cascade include aHUS, hemolytic uremic syndrome (HUS), abdominal aortic aneurysm, hemodialysis complications, hemolytic anemia, or hemodialysis, neuromylitis (NMO), myasthenia gravis (MG), fatty liver, nonalcoholic steatohepatitis (NASH), liver inflammation, cirrhosis, liver failure, dermatomyocitis, and amyotrophic lateral sclerosis.

Factor D is an attractive target for inhibition or regulation of the complement cascade due to its early and essential role in the alternative complement pathway, and its potential role in signal amplification within the classical and lectin complement pathways. Inhibition of Factor D effectively interrupts the pathway and attenuates the formation of the membrane attack complex.

While initial attempts have been made to develop inhibitors of Factor D, there are currently no small molecule Factor D inhibitors in clinical trials. Examples of Factor D inhibitors or prolyl compounds are described in the following disclosures.

Biocryst Pharmaceuticals U.S. Pat. No. 6,653,340 titled “Compounds useful in the complement, coagulat and kallikrein pathways and method for their preparation” describes fused bicyclic ring compounds that are potent inhibitors of Factor D. Development of the Factor D inhibitor BCX1470 was discontinued due to lack of specificity and short half-life of the compound.

Novartis PCT patent publication WO2012/093101 titled “Indole compounds or analogues thereof useful for the treatment of age-related macular degeneration” describes certain Factor D inhibitors. Additional Factor D inhibitors are described in Novartis PCT patent publications WO2014/002051, WO2014/002052, WO2014/002053, WO2014/002054, WO2014/002057, WO2014/002058, WO2014/002059, WO2014/005150, and WO2014/009833.

Bristol-Myers Squibb PCT patent publication WO2004/045518 titled “Open chain prolyl urea-related modulators of androgen receptor function” describes open chain prolyl urea and thiourea related compounds for the treatment of androgen receptor-associated conditions, such as age-related diseases, for example, sarcopenia.

Japan Tobacco Inc. PCT patent publication WO1999/048492 titled “Amide derivatives and nociceptin antagonists” describes compounds with a proline-like core and aromatic substituents connected to the proline core through amide linkages useful for the treatment of pain.

Ferring B. V. and Yamanouchi Pharmaceutical Co. lTD. PCT patent publication WO1993/020099 titled “CCK and/or gastrin receptor ligands” describes compounds with a proline-like core and heterocyclic substituents connected to the proline core through amide linkages for the treatment of, for example, gastric disorders or pain.

Alexion Pharmaceuticals PCT patent publication WO1995/029697 titled “Methods and compositions for the treatment of glomerulonephritis and other inflammatory diseases” discloses antibodies directed to C5 of the complement pathway for the treatment of glomerulonephritis and inflammatory conditions involving pathologic activation of the complement system.

On Feb. 25, 2015, Achillion Pharmaceuticals filed PCT Patent Application No. PCT/US2015/017523 and U.S. patent application Ser. No. 14/631,090 titled “Alkyne Compounds for Treatment of Complement Mediated Disorders”; PCT Patent Application No. PCT/US2015/017538 and U.S. patent application Ser. No. 14/631,233 titled “Amide Compounds for Treatment of Complement Mediated Disorders”; PCT Patent Application No. PCT/US2015/017554 and U.S. patent application Ser. No. 14/631,312 titled “Amino Compounds for Treatment of Complement Mediated Disorders”; PCT Patent Application No. PCT/US2015/017583 and U.S. patent application Ser. No. 14/631,440 titled “Carbamate, Ester, and Ketone Compounds for Treatment of Complement Mediated Disorders”; PCT Patent Application No. PCT/US2015/017593 and U.S. patent application Ser. No. 14/631,625 titled “Aryl, Heteroaryl, and Heterocyclic Compounds for Treatment of Complement Mediated Disorders”; PCT Patent Application No. PCT/US2015/017597 and U.S. patent application Ser. No. 14/631,683 titled “Ether Compounds for Treatment of Complement Mediated Disorders”; PCT Patent Application No. PCT/US2015/017600 and U.S. patent application Ser. No. 14/631,785 titled “Phosphonate Compounds for Treatment of Complement Mediated Disorders”; and PCT Patent Application No. PCT/US2015/017609 and U.S. patent application Ser. No. 14/631,828 titled “Compounds for Treatment of Complement Mediated Disorders.”

Given the wide variety of medical disorders that are caused by detrimental immune or inflammatory responses, new uses and compounds are needed for medical treatment. In one aspect, new uses and compounds are needed to mediate the complement pathway, and for example, which act as Factor D inhibitors for treatment of disorders in a host, including a human, associated with dysregulation of the complement cascade, or with undesired result of the complement cascade performing its normal function.

SUMMARY

In a first embodiment, the invention is the use of a compound of Formula I, or a pharmaceutically acceptable salt or composition thereof, wherein at least one of the R¹² or R¹³ on the A group is a phosphonate substituent including those compounds set out in Table 1, for the treatment of a disorder in a host, typically a human, wherein the disorder is selected from the group disclosed in the Detailed Description, Part IV, Section A. The compounds of Table 1 were first disclosed in PCT Patent Application No. PCT/US2015/017600 and U.S. patent application Ser. No. 14/631,785 titled “Phosphonate Compounds for Treatment of Complement Mediated Disorders,” however, not for the indications now provided in the Detailed Description, Part IV, Section A. The compound is provided in an effective amount to treat the disorder, and optionally in a pharmaceutically acceptable carrier. Therefore, in particular, this first embodiment includes uses of compounds to treat a disorder selected from the group disclosed in the Detailed Description, Part IV, Section A.

Non-limiting examples of disorders described in the Detailed Description, Part IV, Section A include: fatty liver and conditions stemming from fatty liver, nonalcoholic steatohepatitis (NASH), liver inflammation, cirrhosis, liver failure, dermatomyocitis, and amyotrophic lateral sclerosis. In another embodiment of Section A disorders, the active compound is used to modulate an immune response prior to, during, or after surgery or other medical procedure, or as adjunctive therapy to dampen the immune or inflammatory response during a pharmaceutical or biopharmaceutical drug treatment, a blood transfusion, or other allogenic tissue or fluid administration. In one embodiment, a Section A method is provided for the treatment or prevention of cytokine or inflammatory reactions in response to the administration of biotherapeutics (e.g. CAR T-cell therapy) in a host by administering an effective amount of a designated compound herein, or a pharmaceutically acceptable salt thereof, optionally in a pharmaceutically acceptable carrier.

Non-limiting examples of disorders in the Detailed Description, Part IV, Section B of this invention include paroxysmal nocturnal hemoglobinuria (PNH), rheumatoid arthritis, multiple sclerosis, age-related macular degeneration (AMD), retinal degeneration, other ophthalmic diseases (e.g., geographic atrophy), a respiratory disease or a cardiovascular disease. In one aspect, an active compound or its salt or composition can be used to treat a medical disorder which is mediated by either a dysfunctional complement cascade or a disorder or abnormality of a cell that adversely affects the ability of the cell to engage in or respond to normal complement activity, for example, including but not limited to sparing certain cells from complement mediated lysis. PNH is one example of such a disorder, wherein host blood cells are missing the gene PIG-A that expresses a protein that protects the blood cells from complement mediated lysis. Other embodiments of Section B disorders include complement associated disorders that are induced by antibody-antigen interactions, a component of an immune or autoimmune disorder, hereditary angioedema, capillary leak syndrome, atypical hemolytic uremic syndrome (aHUS), hemolytic uremic syndrome (HUS), abdominal aortic aneurysm, hemodialysis complications, hemolytic anemia and hemodialysis.

In a second embodiment of the invention, a phosphonate compound is selected from Table 2 or an active compound that is prepared from or consists of moieties selected from FIG. 1B, 1C, 2B, 2C, 2D, 2E, 3B, 3C, 3D, 3E, 3F, 3G, 3H, 3I, 3J, 3K, 3L, 3M, 3N, 5, 6A, or 6B, and optionally 4B, 4C, 4D, 4E, 4F or a pharmaceutically acceptable composition, salt, isotopic analog or prodrug thereof, for the treatment of an immune or inflammatory disorder in a host, typically a human, including a disorder selected from the group disclosed in the Detailed Description, Part IV, Section A or B. In one embodiment, the compound of Table 2 is used to treat a disorder associated with a dysfunction, including increased activity of the complement pathway that includes the administration of an effective amount of a compound selected from Table 2 or a pharmaceutically acceptable salt thereof, optionally in a pharmaceutically acceptable carrier, as described in more detail below. In one embodiment, the disorder is associated with the alternative complement cascade pathway. In yet another embodiment, the disorder is associated with the complement classical pathway. In a further embodiment, the disorder is associated with the complement lectin pathway. The compound in Table 2 in one embodiment is used to dampen or inhibit detrimental complement activity in a host, by administration of an effective amount in a suitable manner to a host in need thereof. Therefore, in particular, this second embodiment includes compound species, and uses of these species to treat disorders selected from the group disclosed in the Detailed Description, Part IV, Section A or B.

In a third embodiment of the invention, a phosphonate compound is provided selected from Table 3 or a pharmaceutically acceptable composition, salt, isotopic analog or prodrug thereof, for the treatment of an immune or inflammatory disorder in a host, typically a human, including a disorder selected from the group disclosed in the Detailed Description, Part IV, Section A or B. In one embodiment, the compound of Table 3 is used to treat a disorder associated with a dysfunction, including increased activity, of the complement pathway that includes the administration of an effective amount of a compound selected from Table 3 or a pharmaceutically acceptable salt thereof, optionally in a pharmaceutically acceptable carrier, as described in more detail below. In one embodiment, the disorder is associated with the alternative complement cascade pathway. In yet another embodiment, the disorder is associated with the complement classical pathway. In a further embodiment, the disorder is associated with the complement lectin pathway. The compound in Table 3 in one embodiment is used to dampen or inhibit detrimental complement activity in a host, by administration of an effective amount in a suitable manner to a host in need thereof. Therefore, in particular, this third embodiment includes compound species and uses of these species to treat a disorder selected from the group disclosed in the Detailed Description, Part IV, Section A or B.

In a fourth embodiment of the invention, a phosphonate compound is provided that is prepared from or consists of moieties selected from FIGS. 1D, 1E, 5, 6A, 6B, 7A, 7B, 7C, 7D, 7E, and 8; and optionally 4B, 4C, 4D, 4E, or 4F or a pharmaceutically acceptable composition, salt, isotopic analog or prodrug thereof, for the treatment of an immune or inflammatory disorder in a host, typically a human, including a disorder selected from the group disclosed in the Detailed Description, Part IV, Section A. In one embodiment, the compound that is prepared from or consists of moieties selected from FIGS. 1D, 1E, 5, 6A, 6B, 7A, 7B, 7C, 7D, 7E, and 8; and optionally 4B, 4C, 4D, 4E or 4F, is used to treat a disorder associated with a dysfunction, including increased activity, of the complement pathway that includes the administration of an effective amount of the compound or an embodiment of the active compound, or a pharmaceutically acceptable salt thereof, optionally in a pharmaceutically acceptable carrier, as described in more detail below. In one embodiment, the disorder is associated with the alternative complement cascade pathway. In yet another embodiment, the disorder is associated with the complement classical pathway. In a further embodiment, the disorder is associated with the complement lectin pathway. The compound in one embodiment provided herein is used to dampen or inhibit detrimental complement activity in a host, by administration of an effective amount in a suitable manner to a host in need thereof. Therefore, in particular, this fourth embodiment includes uses of these compounds to treat disorder selected from the group disclosed in the Detailed Description, Part IV, Section A.

In a fifth embodiment of the invention, a phosphonate compound is provided that is prepared from or consists of moieties selected from FIGS. 1B, 1C, 1D, 1E, 3A, 3B, 3C, 3D, 3E, 3F, 3G, 3H, 3I, 3J, 3K, 3L, 3M, 3N, 3O, 3P, 3Q, 5, 6A, 6B, and 7F; and optionally 4B, 4C, 4D, 4E, or 4F or a pharmaceutically acceptable composition, salt, isotopic analog or prodrug thereof, for the treatment of an immune or inflammatory disorder in a host, typically a human, including a disorder selected from the group disclosed in the Detailed Description, Part IV, Section A or B. In one embodiment, the compound that is prepared from or consists of moieties selected from FIGS. 1B, 1C, 1D, 1E, 3A, 3B, 3C, 3D, 3E, 3F, 3G, 3H, 3I, 3J, 3K, 3L, 3M, 3N, 3O, 3P, 3Q, 5, 6A, 6B, and 7F; and optionally 4B, 4C, 4D, 4E, or 4F, is used to treat a disorder associated with a dysfunction, including increased activity, of the complement pathway that includes the administration of an effective amount of the compound or an embodiment of the active compound, or a pharmaceutically acceptable salt thereof, optionally in a pharmaceutically acceptable carrier, as described in more detail below. In one embodiment, the disorder is associated with the alternative complement cascade pathway. In yet another embodiment, the disorder is associated with the complement classical pathway. In a further embodiment, the disorder is associated with the complement lectin pathway. The compound in one embodiment provided herein is used to dampen or inhibit detrimental complement activity in a host, by administration of an effective amount in a suitable manner to a host in need thereof. Therefore, in particular, this fifth embodiment includes compound species and uses of these species to treat disorder selected from the group disclosed in the Detailed Description, Part IV, Section A or B.

In a sixth embodiment of the invention, a phosphonate compound is provided that is prepared from or consists of moieties selected from FIGS. 1B, 1C, 1D, 1E, 3A, 3B, 3C, 3D, 3E, 3F, 3G, 3H, 3I, 3J, 3K, 3L, 3M, 3N, 3O, 3P, 3Q, 5, 6A, 6B, 7G, and 8; and optionally 4B, 4C, 4D, 4E and 4F, or a pharmaceutically acceptable composition, salt, isotopic analog or prodrug thereof, for the treatment of an immune or inflammatory disorder in a host, typically a human, including a disorder selected from the group disclosed in the Detailed Description, Part IV, Section A. In one embodiment, the compound that is prepared from or consists of moieties selected from FIGS. 1B, 1C, 1D, 1E, 3A, 3B, 3C, 3D, 3E, 3F, 3G, 3H, 3I, 3J, 3K, 3L, 3M, 3N, 3O, 3P, 3Q, 5, 6A, 6B, 7G, and 8; and optionally 4B, 4C, 4D, 4E and 4F, is used to treat a disorder associated with a dysfunction, including increased activity, of the complement pathway that includes the administration of an effective amount of the compound or an embodiment of the active compound, or a pharmaceutically acceptable salt thereof, optionally in a pharmaceutically acceptable carrier, as described in more detail below. In one embodiment, the disorder is associated with the alternative complement cascade pathway. In yet another embodiment, the disorder is associated with the complement classical pathway. In a further embodiment, the disorder is associated with the complement lectin pathway. The compound in one embodiment provided herein is used to dampen or inhibit detrimental complement activity in a host, by administration of an effective amount in a suitable manner to a host in need thereof. Therefore, in particular, this sixth embodiment includes uses of these species to treat disorder selected from the group disclosed in the Detailed Description, Part IV, Section A.

In a sixth embodiment of the invention, a phosphonate compound as described and used herein is selected from those depicted in FIGS. 9A, 9B, 9C, 9D, 9E, 9F, 9G and 9H, and FIGS. 6A, and 6B, or a pharmaceutically acceptable composition, salt, isotopic analog or prodrug thereof, for the treatment of an immune or inflammatory disorder in a host, typically a human, including a disorder selected from the group disclosed in the Detailed Description, Part IV, Section A or B. In one embodiment, the compound of FIG. 9A, 9B, 9C, 9D, 9E, 9F, 9G or 9H, and FIGS. 6A, and 6B, is used to treat a disorder associated with a dysfunction, including increased activity of the complement pathway that includes the administration of an effective amount of a compound selected from FIG. 9A, 9B, 9C, 9D, 9E, 9F, 9G or 9H, and FIGS. 6A, and 6B, or a pharmaceutically acceptable salt thereof, optionally in a pharmaceutically acceptable carrier, as described in more detail below. In one embodiment, the disorder is associated with the alternative complement cascade pathway. In yet another embodiment, the disorder is associated with the complement classical pathway. In a further embodiment, the disorder is associated with the complement lectin pathway. The compound in FIG. 9A, 9B, 9C, 9D, 9E, 9F, 9G or 9H, and FIGS. 6A and 6B, in one embodiment is used to dampen or inhibit detrimental complement activity in a host, by administration of an effective amount in a suitable manner to a host in need thereof. Therefore, in particular, this seventh embodiment includes compound species, and uses of these species to treat disorder selected from the group disclosed in the Detailed Description, Part IV, Section A or B.

Compounds disclosed herein or used as described herein may be administered in any desired route according to the direction of the healthcare provider, for example, oral, topical, parenteral, by inhalation or spray, sublingual, via implant, including ocular implant, transdermal, via buccal administration, rectal, as an ophthalmic solution, injection, including ocular injection, intravenous, intra-aortal, intracranial, subdermal, intraperitoneal, subcutaneous, transnasal, sublingual, or rectal or by other means, in dosage unit formulations optionally containing conventional pharmaceutically acceptable carriers, and in an immediate or controlled release fashion. For use in the eye, any of the compounds described herein can be administered to the eye in any desired form of administration, including via intravitreal, intrastromal, intracameral, sub-tenon, sub-retinal, retro-bulbar, peribulbar, suprachoroidal, choroidal, subchoroidal, conjunctival, subconjunctival, episcleral, posterior juxtascleralscleral, circumcorneal, and tear duct injections, or through a mucus, mucin, or a mucosal barrier, in an immediate or controlled release fashion.

The compounds of Formula I are of the formula:

and the pharmaceutically acceptable salts and compositions thereof, wherein:

Q¹ is N(R¹) or C(R¹R^(1′));

Q² is C(R²R^(2′)), C(R²R^(2′))—C(R²R^(2′)), S, O, N(R²) or C(R²R^(2′))O;

Q³ is N(R³), S, or C(R³R^(3′));

X¹ and X² are independently N, CH, or CZ, or X¹ and X² together are C═C; and

wherein Q¹, Q², Q³, X¹, and X² are selected such that a stable compound results.

R and R′ (see FIG. 5) are independently selected from H, alkyl, cycloalkyl, cycloalkylalkyl, heterocycle, heterocycloalkyl, aryl, arylalkyl, heteroaryl, heteroarylalkyl wherein each group can be optionally substituted or any other substituent group herein that provides the desired properties. In some embodiments, the core ring includes one or more chiral carbon atoms. The invention includes the use of compounds with embodiments in which the chiral carbon can be provided as an enantiomer, or mixtures of enantiomers, including a racemic mixture. Where the core ring includes more than one stereocenter, all of the enantiomers and diastereomers are included in the invention as individual species.

Z is F, Cl, NH₂, CH₃, CH₂D, CHD₂, or CD₃.

R¹, R^(1′), R², R^(2′), R³, and R^(3′) are independently selected at each occurrence, as appropriate, and only where a stable compound results, from hydrogen, halogen, hydroxyl, nitro, cyano, amino, C₁-C₆alkyl, C₂-C₆alkenyl, C₂-C₆alkynyl, C₁-C₆alkoxy, C₂-C₆alkynyl, C₂-C₆alkanoyl, C₁-C₆thioalkyl, hydroxyC₁-C₆alkyl, aminoC₁-C₆alkyl, —C₀-C₄alkylNR⁹R¹⁰, —C(O)OR⁹, —OC(O)R⁹, —NR⁹C(O)R¹⁰, —C(O)NR⁹R¹⁰, —OC(O)NR⁹R¹⁰, —NR⁹C(O)OR¹⁰, C₁-C₂haloalkyl, and C₁-C₂haloalkoxy, where R⁹ and R¹⁰ are independently selected at each occurrence from hydrogen, C₁-C₆alkyl, (C₃-C₇cycloalkyl)C₀-C₄alkyl, —C₀-C₄alkyl(C₃-C₇cycloalkyl), and —O—C₀-C₄alkyl(C₃-C₇cycloalkyl).

In alternative embodiments, R¹ and R^(1′) or R³ and R^(3′) may be taken together to form a 3- to 6-membered carbocyclic spiro ring or a 3- to 6-membered heterocyclic spiro ring containing 1 or 2 heteroatoms independently selected from N, O, or S; R² and R^(2′) may be taken together to form a 3- to 6-membered carbocyclic spiro ring; or R² and R^(2′) may be taken together to form a 3- to 6-membered heterocyclic spiro ring; each of which spiro ring each of which ring may be unsubstituted or substituted with 1 or more substituents independently selected from halogen (and in particular F), hydroxyl, cyano, —COOH, C₁-C₄alkyl (including in particular methyl), C₂-C₄alkenyl, C₂-C₄alkynyl, C₁-C₄alkoxy, C₂-C₄alkanoyl, hydroxyC₁-C₄alkyl, (mono- and di-C₁-C₄alkylamino)C₀-C₄alkyl, —C₀-C₄alkyl(C₃-C₇cycloalkyl), —O—C₀-C₄alkyl(C₃-C₇cycloalkyl), C₁-C₂haloalkyl, and C₁-C₂haloalkoxy.

In alternative embodiments, R¹ and R² may be taken together to form a 3-membered carbocyclic ring; R¹ and R² may be taken together to form a 4- to 6-membered carbocyclic or aryl ring or a 4- to 6-membered heterocyclic or heteroaryl ring containing 1 or 2 heteroatoms independently selected from N, O, and S; or R² and R³, if bound to adjacent carbon atoms, may be taken together to form a 3- to 6-membered carbocyclic or aryl ring or a 3- to 6-membered heterocyclic or heteroaryl ring; each of which ring may be unsubstituted or substituted with 1 or more substituents independently selected from halogen (and in particular F), hydroxyl, cyano, —COOH, C₁-C₄alkyl (including in particular methyl), C₂-C₄alkenyl, C₂-C₄alkynyl, C₁-C₄alkoxy, C₂-C₄alkanoyl, hydroxyC₁-C₄alkyl, (mono- and di-C₁-C₄alkylamino)C₀-C₄alkyl, —C₀-C₄alkyl(C₃-C₇cycloalkyl), —O—C₀-C₄alkyl(C₃-C₇cycloalkyl), C₁-C₂haloalkyl, and C₁-C₂haloalkoxy.

In alternative embodiments, R¹ and R^(1′), R² and R^(2′), or R³ and R^(3′) can be taken together to form a carbonyl group. In alternative embodiments, R¹ and R² or R² and R³ can be taken together to form a carbon-carbon double bond.

Non-limiting examples of the

ring are illustrated, for example, in FIG. 5 (any of which can be otherwise substituted with R¹, R^(1′), R², R^(2′), R³, and R^(3′)).

In an alternate embodiment, the

ring is replaced by one of the following core structures:

wherein q is 0, 1, 2 or 3 and r is 1, 2 or 3,

is a single or double bond. Examples of core structures are provided in FIGS. 3B, 3C, 3D, 3E, 3F, 3G, 3H, 3I, 3J, 3K, 3L, 3M, 3N, 3O, 3P, 3Q, and 5.

A is a group selected from:

Examples of “A” groups are in FIGS. 1B, 1C, 1D, and 1E.

R⁴ is selected from —CHO, —CONH₂, C₂-C₆alkanoyl, hydrogen, —SO₂NH₂, —C(CH₂)₂F, —CH(CF₃)NH₂, C₁-C₆alkyl, —C₀-C₄alkyl(C₃-C₇cycloalkyl), —C(O)C₀-C₂alkyl(C₃-C₇cycloalkyl),

each of which R⁴ other than hydrogen, —CHO, and —CONH₂, is unsubstituted or substituted with one or more of amino, imino, halogen, hydroxyl, cyano, cyanoimino, C₁-C₂alkyl, C₁-C₂alkoxy, —C₀-C₂alkyl(mono- and di-C₁-C₄alkylamino), C₁-C₂haloalkyl, and C₁-C₂haloalkoxy.

R⁵ and R⁶ are independently selected from —CHO, —C(O)NH₂, —C(O)NH(CH₃), C₂-C₆alkanoyl, hydrogen, hydroxyl, halogen, cyano, nitro, —COOH, —SO₂NH₂, vinyl, C₁-C₆alkyl (including methyl), C₂-C₆alkenyl, C₁-C₆alkoxy, —C₀-C₄alkyl(C₃-C₇cycloalkyl), —C(O)C₀-C₄alkyl(C₃-C₇cycloalkyl), —P(O)(OR⁹)₂, —OC(O)R⁹, —C(O)OR⁹, —C(O)N(CH₂CH₂R⁹)(R¹⁰), —NR⁹C(O)R¹⁰, phenyl, or 5- to 6-membered heteroaryl.

Each R⁵ and R⁶ other than hydrogen, hydroxyl, cyano, and —COOH is unsubstituted or optionally substituted. For example, R⁵ and R⁶ other than hydrogen, hydroxyl, cyano, and —COOH may be substituted with one or more substituents independently selected from halogen, hydroxyl, amino, imino, cyano, cyanoimino, C₁-C₂alkyl, C₁-C₄alkoxy, —C₀-C₂alkyl(mono- and di-C₁-C₄alkylamino), C₁-C₂haloalkyl, and C₁-C₂haloalkoxy.

R^(6′) is hydrogen, halogen, hydroxyl, C₁-C₄alkyl, —C₀-C₄alkyl(C₃-C₇cycloalkyl), or C₁-C₄alkoxy; or R⁶ and R^(6′) may be taken together to form an oxo, vinyl, or imino group.

R⁷ is hydrogen, C₁-C₆alkyl, or —C₀-C₄alkyl(C₃-C₇cycloalkyl).

R⁸ and R^(8′) are independently selected from hydrogen, halogen, hydroxyl, C₁-C₆alkyl, —C₀-C₄alkyl(C₃-C₇cycloalkyl), C₁-C₆alkoxy, and (C₁-C₄alkylamino)C₀-C₂alkyl; or R⁸ and R^(8′) are taken together to form an oxo group; or R⁸ and R^(8′) can be taken together with the carbon that they are bonded to form a 3-membered carbocyclic ring.

R¹⁶ is absent or may be independently selected from halogen, hydroxyl, nitro, cyano, C₁-C₆alkyl, C₂-C₆alkenyl, C₂-C₆alkanoyl, C₁-C₆alkoxy, —C₀-C₄alkyl(mono- and di-C₁-C₆alkylamino), —C₀-C₄alkyl(C₃-C₇cycloalkyl), C₁-C₂haloalkyl, and C₁-C₂haloalkoxy.

R¹⁹ is hydrogen, C₁-C₆alkyl, C₂-C₆alkenyl, C₂-C₆alkanoyl, —SO₂C₁-C₆alkyl, (mono- and di-C₁-C₆alkylamino)C₁-C₄alkyl, —C₀-C₄alkyl(C₃-C₇cycloalkyl), —C₀-C₄alkyl(C₃-C₇heterocycloalkyl), —C₀-C₄alkyl(aryl), C₀-C₄alkyl(heteroaryl), and wherein R¹⁹ other than hydrogen is unsubstituted or substituted with one or more substituents independently selected from halogen, hydroxyl, amino, —COOH, and —C(O)OC₁-C₄alkyl.

X¹¹ is N or CR¹¹.

X¹² is N or CR¹².

X¹³ is N or CR¹³.

X¹⁴ is N or CR¹⁴.

No more than 2 of X¹¹, X¹², X¹³, and X¹⁴ are N.

One of R¹² or R¹³ is R³². In one embodiment, one of R¹² and R¹³ is selected from R³¹ and the other of R¹² and R¹³ is selected from R³². In an alternative embodiment, R¹² and R¹³ are each independently selected from an R³² moiety.

R³¹ is selected from hydrogen, halogen, hydroxyl, nitro, cyano, amino, —COOH, C₁-C₂haloalkyl, C₁-C₂haloalkoxy, C₁-C₆alkyl, —C₀-C₄alkyl(C₃-C₇cycloalkyl), C₂-C₆alkenyl, C₂-C₆alkanoyl, C₁-C₆alkoxy, C₂-C₆alkenyloxy, —C(O)OR⁹, C₁-C₆thioalkyl, —C₀-C₄alkylNR⁹R¹⁰, —C(O)NR⁹R¹⁰, —SO₂R⁹, —SO₂NR⁹R¹⁰, —OC(O)R⁹, and —C(NR⁹)NR⁹R¹⁰, each of which R³¹ other than hydrogen, halogen, hydroxyl, nitro, cyano, C₁-C₂haloalkyl, and C₁-C₂haloalkoxy is unsubstituted or substituted with one or more substituents independently selected from halogen, hydroxyl, nitro, cyano, amino, —COOH, —CONH₂C₁-C₂haloalkyl, and C₁-C₂haloalkoxy, and each of which R³¹ is also optionally substituted with one substituent selected from phenyl and 4- to 7-membered heterocycle containing 1, 2, or 3 heteroatoms independently selected from N, O, and S; which phenyl or 4- to 7-membered heterocycle is unsubstituted or substituted with one or more substituents independently selected from halogen, hydroxyl, nitro, cyano, C₁-C₆alkyl, C₂-C₆alkenyl, C₂-C₆alkanoyl, C₁-C₆alkoxy, (mono- and di-C₁-C₆alkylamino)C₀-C₄alkyl, C₁-C₆alkylester, —C₀-C₄alkyl)(C₃-C₇cycloalkyl), C₁-C₂haloalkyl, and C₁-C₂haloalkoxy;

R³² is —P(O)R²⁰R²⁰.

R³² is the same as Z³².

R²⁰ is independently selected at each occurrence from hydroxyl, C₁-C₆alkoxy, C₁-C₆haloalkoxy, C₁-C₆alkyl, (C₃-C₇cycloalkyl)C₀-C₄alkyl-, (aryl)C₀-C₄alkyl-, —O—C₀-C₄alkyl(aryl), —O—C₀-C₄alkyl(C₃-C₇cycloalkyl), (4- to 7-membered heterocycloalkyl)C₀-C₄alkyl-O— having 1, 2, or 3 heteroatoms independently selected from N, O, and S; (5- or 6-membered unsaturated or aromatic heterocycle)C₀-C₄alkyl-O— having 1, 2, or 3 heteroatoms independently selected from N, O, and S; —O(CH₂)₂₋₄O(CH₂)₈₋₁₈, —OC(R^(20a))₂OC(O)OR^(20b), —OC(R^(20a))₂OC(O)R^(20b), —NR⁹R¹⁰, an N-linked amino acid or an N-linked amino acid ester and each R²⁰ can be optionally substituted;

R^(20a) is independently selected at each occurrence from hydrogen, C₁-C₈alkyl, C₂-C₈alkenyl, C₂-C₈alkynyl, (aryl)C₀-C₄alkyl-, (aryl)C₂-C₈alkenyl- or (aryl)C₂-C₈alkynyl-; or

two R^(20a) groups can be taken together with the carbon that they are bonded to form a 3-6 membered heterocycloalkyl having 1, 2, or 3 heteroatoms independently selected from N, O, and S, or a 3-6 membered carbocyclic ring.

R^(20b) is independently selected at each occurrence from C₁-C₈alkyl, C₂-C₈alkenyl, C₂-C₈alkynyl, (aryl)C₀-C₄alkyl, (aryl)C₂-C₈alkenyl or (aryl)C₂-C₈alkynyl.

When A is an indole or indazole and X¹² is N, X¹³ is CR¹³, wherein R¹³ is R³².

When A is an indole or indazole and X¹³ is N, X¹² is CR¹², wherein R¹² is R³².

R¹¹, R¹⁴, and R¹⁵ are independently selected at each occurrence from hydrogen, halogen, hydroxyl, nitro, cyano, —O(PO)(OR⁹)₂, —(PO)(OR⁹)₂, C₁-C₆alkyl, C₂-C₆alkenyl, C₂-C₆alkynyl, C₂-C₆alkenyl(aryl), C₂-C₆alkenyl(cycloalkyl), C₂-C₆alkenyl(heterocycle), C₂-C₆alkenyl(heteroaryl), C₂-C₆alkynyl, C₂-C₆alkynyl(aryl), C₂-C₆alkynyl(cycloalkyl), C₂-C₆alkynyl(heterocycle), C₂-C₆alkynyl(heteroaryl), C₂-C₆alkanoyl, C₁-C₆alkoxy, C₁-C₆thioalkyl, —C₀-C₄alkyl(mono- and di-C₁-C₆alkylamino), —C₀-C₄alkyl(C₃-C₇cycloalkyl), —C₀-C₄alkoxy(C₃-C₇cycloalkyl), C₁-C₂haloalkyl, and C₁-C₂haloalkoxy.

L is a bond or is selected from the formulas

where R¹⁷ is hydrogen, C₁-C₆alkyl, or —C₀-C₄alkyl(C₃-C₇cycloalkyl) and R¹⁸ and R^(18′) are independently selected from hydrogen, halogen, hydroxymethyl, and methyl; and m is 0, 1, 2, or 3.

Linkers are also illustrated in FIGS. 4B, 4C, 4D, 4E, 4F, and 4G.

B is a monocyclic or bicyclic carbocyclic; a monocyclic or bicyclic carbocyclic-oxy group; a monocyclic, bicyclic, or tricyclic heterocyclic group having 1, 2, 3, or 4 heteroatoms independently selected from N, O, and S and from 4 to 7 ring atoms per ring; C₂-C₆alkenyl; C₂-C₆alkynyl; —(C₀-C₄alkyl)(aryl); —(C₀-C₄alkyl)(heteroaryl); or —(C₀-C₄alkyl)(biphenyl), and B is unsubstituted or substituted with one or more substituents independently selected from R³³ and R³⁴, and 0 or 1 substituents selected from R³⁵ and R³⁶.

R³³ is independently selected from halogen, hydroxyl, —COOH, cyano, C₁-C₆alkyl, C₂-C₆alkanoyl, C₁-C₆alkoxy, —C₀-C₄alkylNR⁹R¹⁰, —SO₂R⁹, C₁-C₂haloalkyl, and C₁-C₂haloalkoxy;

R³⁴ is independently selected from nitro, C₂-C₆alkenyl, C₂-C₆alkynyl, C₁-C₆thioalkyl, -JC₃-C₇cycloalkyl, —B(OH)₂, -JC(O)NR⁹R²³, -JOSO₂OR²¹, —C(O)(CH₂)₁₋₄S(O)R²¹, —O(CH₂)₁₋₄S(O)NR²¹R²², -JOP(O)(OR²¹)(OR²²), -JP(O)(OR²¹)(OR²²), -JOP(O)(OR²¹⁾R²², -JP(O)(OR²¹)R²², -JOP(O)R²¹R²², -JP(O)R²¹R²², -JSP(O)(OR²¹)(OR²²), -JSP(O)(OR²¹)(R²²), -JSP(O)(R²¹)(R²²), -JNR⁹P(O)(NHR²¹)(NHR²²), -JNR⁹P(O)(OR²¹)(NHR²²), -JNR⁹P(O)(OR²¹)(OR²²), -JC(S)R²¹, -JNR²¹SO₂R²², -JNR⁹S(O)NR¹⁰R²², -JNR⁹SO₂NR¹⁰R²², -JSO₂NR⁹COR²², -JSO₂NR⁹CONR²¹R²², -JNR²¹SO₂R²², -JC(O)NR²¹SO₂R²², -JC(NH₂)NR²², -JC(NH₂)NR⁹S(O)₂R²², -JOC(O)NR²¹R²², -JNR²¹C(O)OR²², -JNR²¹OC(O)R²², —(CH₂)₁₋₄C(O)NR²¹R²², -JC(O)NR²⁴R²⁵, -JNR⁹C(O)R²¹, -JC(O)R²¹, -JNR⁹C(O)NR¹⁰R²², —CCR²¹, —(CH₂)₁₋₄OC(O)R²¹, and -JC(O)OR²³; each of which R³⁴ may be unsubstituted or substituted with one or more substituents independently selected from halogen, hydroxyl, nitro, cyano, amino, oxo, —B(OH)₂, —Si(CH₃)₃, —COOH, —CONH₂, —P(O)(OH)₂, C₁-C₆alkyl, —C₀-C₄alkyl(C₃-C₇cycloalkyl), C₁-C₆alkoxy, —C₀-C₂alkyl(mono- and di-C₁-C₄alkylamino), C₁-C₆alkylester, C₁-C₄alkylamino, C₁-C₄hydroxylalkyl, C₁-C₂haloalkyl, and C₁-C₂haloalkoxy.

R³⁵ is independently selected from naphthyl, naphthyloxy, indanyl, (4- to 7-membered heterocycloalkyl)C₀-C₄alkyl containing 1 or 2 heteroatoms selected from N, O, and S, and bicyclic heterocycle containing 1, 2, or 3 heteroatoms independently selected from N, O, and S, and containing 4- to 7-ring atoms in each ring; each of which R³⁵ is unsubstituted or substituted with one or more substituents independently selected from halogen, hydroxyl, nitro, cyano, C₁-C₆alkyl, C₂-C₆alkenyl, C₂-C₆alkanoyl, C₁-C₆alkoxy, (mono- and di-C₁-C₆alkylamino)C₀-C₄alkyl, C₁-C₆alkylester, —C₀-C₄alkyl(C₃-C₇cycloalkyl), —SO₂R⁹, C₁-C₂haloalkyl, and C₁-C₂haloalkoxy.

R³⁶ is independently selected from tetrazolyl, (phenyl)C₀-C₂alkyl, (phenyl)C₁-C₂alkoxy, phenoxy, and 5- or 6-membered heteroaryl containing 1, 2, or 3 heteroatoms independently selected from N, O, B, and S, each of which R³⁶ is unsubstituted or substituted with one or more substituents independently selected from halogen, hydroxyl, nitro, cyano, C₁-C₆alkyl, C₂-C₆alkenyl, C₂-C₆alkanoyl, C₁-C₆alkoxy, (mono- and di-C₁-C₆alkylamino)C₀-C₄alkyl, C₁-C₆alkylester, —C₀-C₄alkyl(C₃-C₇cycloalkyl), —SO₂R⁹, —OSi(CH₃)₂C(CH₃)₃, —Si(CH₃)₂C(CH₃)₃, C₁-C₂haloalkyl, and C₁-C₂haloalkoxy.

In one additional alternative embodiment B is selected from:

In one additional alternative embodiment R³⁶ is selected from:

In one embodiment R¹ is selected from F, Cl, Br, and C₁-C₆alkyl.

In one embodiment R¹ is selected from hydroxyl and C₁-C₆alkoxy.

In one embodiment R¹ is selected from C₂-C₆alkynyl, C₂-C₆alkanoyl, and C₁-C₆thioalkyl.

In one embodiment R¹ is selected from aminoC₁-C₆alkyl and —C₀-C₄alkylNR⁹R¹⁰.

R²¹ and R²² are independently selected at each occurrence from hydrogen, hydroxyl, cyano, amino, C₁-C₆alkyl, C₁-C₆haloalkyl, C₁-C₆alkoxy, (C₃-C₇cycloalkyl)C₀-C₄alkyl, (phenyl)C₀-C₄alkyl, —C₁-C₄alkylOC(O)OC₁-C₆alkyl, —C₁-C₄alkylOC(O)C₁-C₆alkyl, —C₁-C₄alkylC(O)OC₁-C₆alkyl, (4- to 7-membered heterocycloalkyl)C₀-C₄alkyl having 1, 2, or 3 heteroatoms independently selected from N, O, and S, and (5- or 6-membered unsaturated or aromatic heterocycle)C₀-C₄alkyl having 1, 2, or 3 heteroatoms independently selected from N, O, and S, and each R²¹ and R²² can be optionally substituted.

R²³ is independently selected at each occurrence from (C₃-C₇cycloalkyl)C₀-C₄alkyl, (aryl)C₀-C₄alkyl, (4- to 7-membered heterocycloalkyl)C₀-C₄alkyl having 1, 2, or 3 heteroatoms independently selected from N, O, and S, and (5- or 6-membered unsaturated or aromatic heterocycle)C₀-C₄alkyl having 1, 2, or 3 heteroatoms independently selected from N, O, and S each of which is optionally substituted.

R²⁴ and R²⁵ are taken together with the nitrogen to which they are attached to form a 4- to 7-membered monocyclic heterocycloalkyl group, or a 6- to 10-membered bicyclic heterocyclic group having fused, spiro, or bridged rings, and each R²⁴ and R²⁵ can be optionally substituted.

J is independently selected at each occurrence from a covalent bond, C₁-C₄alkylene, —OC₁-C₄alkylene, C₂-C₄alkenylene, and C₂-C₄alkynylene.

The present invention thus includes at least the following features:

-   (a) A phosphonate compound of Formula I, including those compounds     listed in Table 1, as described herein, and pharmaceutically     acceptable salts and prodrugs thereof, for use in treating or     preventing a disorder listed in the Detailed Description, Part IV,     Section A, including but not limited to the development of fatty     liver and conditions stemming from fatty liver, such as nonalcoholic     steatohepatitis (NASH), liver inflammation, cirrhosis, liver     failure; dermatomyocitis; amyotrophic lateral sclerosis; and     cytokine or inflammatory reactions in response to biotherapeutics     (e.g. CAR T-cell therapy); -   (b) A phosphonate compound of Table 2 or Table 3 or an active     compound that is prepared from or consists of moieties selected from     FIG. 1B, 1C, 2B, 2C, 2D, 2E, 3B, 3C, 3D, 3E, 3F, 3G, 3H, 3I, 3J, 3K,     3L, 3M, 3N, 6A, 6B or 8, and optionally 4B, 4C, 4D, 4E or 4F, as     described herein, and pharmaceutically acceptable salts and prodrugs     thereof, for use in treating or preventing a disorder listed in the     Detailed Description, Part IV, Section A, including but not limited     to the development of fatty liver and conditions stemming from fatty     liver, such as nonalcoholic steatohepatitis (NASH), liver     inflammation, cirrhosis, liver failure, dermatomyocitis; amyotrophic     lateral sclerosis; and cytokine or inflammatory reactions in     response to the administration of biotherapeutics (e.g. CAR T-cell     therapy); -   (c) A phosphonate compound of Table 2 or Table 3 or an embodiment of     the active compound as described FIG. 1B, 1C, 2B, 2C, 2D, 2E, 3B,     3C, 3D, 3E, 3F, 3G, 3H, 3I, 3J, 3K, 3L, 3M, 3N, 6A, 6B or 8, and     optionally 4B, 4C, 4D, 4E or 4F, as described herein, and     pharmaceutically acceptable salts and prodrugs thereof, for use in     treating or preventing a disorder listed in the Detailed     Description, Part IV, Section B of this invention, including but not     limited to paroxysmal nocturnal hemoglobinuria (PNH), C3     glomerulonephritis, rheumatoid arthritis, multiple sclerosis,     age-related macular degeneration (AMD), retinal degeneration, other     ophthalmic diseases (e.g., geographic atrophy), a respiratory     disease or a cardiovascular disease; -   (d) A pharmaceutically acceptable composition of a phosphonate     compound of Table 2 or Table 3 or a phosphonate compound that is     prepared from or consists of moieties selected from FIG. 1B, 1C, 2B,     2C, 2D, 2E, 3B, 3C, 3D, 3E, 3F, 3G, 3H, 3I, 3J, 3K, 3L, 3M, 3N, 6A,     6B or 8, and optionally 4B, 4C, 4D, 4E or 4F, or its     pharmaceutically acceptable salt in a pharmaceutically acceptable     carrier; -   (e) A phosphonate compound selected from Table 2 or Table 3 or a     compound that is prepared from or consists of moieties selected from     FIG. 1B, 1C, 2B, 2C, 2D, 2E, 3B, 3C, 3D, 3E, 3F, 3G, 3H, 3I, 3J, 3K,     3L, 3M, 3N, 6A, 6B or 8, and optionally 4B, 4C, 4D, 4E or 4F, as     described herein, and pharmaceutically acceptable salts, prodrugs     and pharmaceutically acceptable compositions thereof; -   (f) A phosphonate compound selected from Table 2 or Table 3 or a     compound that is prepared from or consists of moieties selected from     FIG. 1B, 1C, 2B, 2C, 2D, 2E, 3B, 3C, 3D, 3E, 3F, 3G, 3H, 3I, 3J, 3K,     3L, 3M, 3N, 6A, 6B or 8, and optionally 4B, 4C, 4D, 4E or 4F, as     described herein, and pharmaceutically acceptable salts and prodrugs     thereof, for use in treating or preventing disorders mediated by the     complement pathway, and for example, cascade Factor D; -   (g) Use of a compound of Formula I, including those compounds listed     in Table 1, as described herein, and pharmaceutically acceptable     salts and prodrugs thereof, in the manufacture of a medicament for     treating or preventing a disorder listed in the Detailed     Description, Part IV, Section A, including but not limited to the     development of fatty liver and conditions stemming from fatty liver,     such as nonalcoholic steatohepatitis (NASH), liver inflammation,     cirrhosis, liver failure; dermatomyocitis; amyotrophic lateral     sclerosis; and cytokine or inflammatory reactions in response to     biotherapeutics (e.g. CAR T-cell therapy); -   (h) Use of a compound of Table 2 or Table 3 that is prepared from or     consists of moieties selected from FIG. 1B, 1C, 2B, 2C, 2D, 2E, 3B,     3C, 3D, 3E, 3F, 3G, 3H, 3I, 3J, 3K, 3L, 3M, 3N, 6A, 6B or 8, and     optionally 4B, 4C, 4D, 4E or 4F, as described herein, and     pharmaceutically acceptable salts and prodrugs thereof, in the     manufacture of a medicament for treating or preventing a disorder     listed in the Detailed Description, Part IV, Section A, including     but not limited to the development of fatty liver and conditions     stemming from fatty liver, such as nonalcoholic steatohepatitis     (NASH), liver inflammation, cirrhosis, liver failure;     dermatomyocitis; amyotrophic lateral sclerosis; and cytokine or     inflammatory reactions in response to biotherapeutics (e.g. CAR     T-cell therapy); -   (i) Use of a compound of Table 2 or Table 3 or a compound that is     prepared from or consists of moieties selected from FIG. 1B, 1C, 2B,     2C, 2D, 2E, 3B, 3C, 3D, 3E, 3F, 3G, 3H, 3I, 3J, 3K, 3L, 3M, 3N, 6A,     6B or 8, and optionally 4B, 4C, 4D, 4E or 4F, as described herein,     and pharmaceutically acceptable salts and prodrugs thereof, in the     manufacture of a medicament for treating or preventing a disorder     listed in the Detailed Description, Part IV, Section B of this     invention, including but not limited to paroxysmal nocturnal     hemoglobinuria (PNH), C3 glomerulonephritis, rheumatoid arthritis,     multiple sclerosis, age-related macular degeneration (AMD), retinal     degeneration, other ophthalmic diseases (e.g., geographic atrophy),     a respiratory disease or a cardiovascular disease; -   (j) A process for manufacturing a medicament intended for the     therapeutic use for treating or preventing a disorder listed in the     Detailed Description, Part IV, Section A or Section B, or generally     for treating or preventing disorders mediated by complement cascade     Factor D, including age-related macular degeneration (AMD), retinal     degeneration, paroxysymal nocturnal hemoglobinuria (PNH), C3     glomerulonephritis, multiple sclerosis (MS), and rheumatoid     arthritis (RA) and other disorders described further herein     characterized in that a compound selected from Table 2 or Table 3 or     a compound that is prepared from or consists of moieties selected     from FIG. 1B, 1C, 2B, 2C, 2D, 2E, 3B, 3C, 3D, 3E, 3F, 3G, 3H, 3I,     3J, 3K, 3L, 3M, 3N, 6A, 6B or 8, and optionally 4B, 4C, 4D, 4E or     4F, is used in the manufacture; -   (k) A compound selected from Table 2 or Table 3 or a compound that     is prepared from or consists of moieties selected from FIG. 1B, 1C,     2B, 2C, 2D, 2E, 3B, 3C, 3D, 3E, 3F, 3G, 3H, 3I, 3J, 3K, 3L, 3M, 3N,     6A, 6B or 8, and optionally 4B, 4C, 4D, 4E or 4F, as described     herein in substantially pure form (e.g., at least 90 or 95%): -   (l) A phosphonate compound of Formula I, including those compounds     listed in Table 1, as described herein, and pharmaceutically     acceptable salts and prodrugs thereof, for use in treating a medical     disorder which is an inflammatory or immune condition, a disorder     mediated by the complement cascade (including a dysfunctional     cascade), a disorder or abnormality of a cell that adversely affects     the ability of the cell to engage in or respond to normal complement     activity, or an undesired complement-mediated response to a medical     treatment, such as surgery or other medical procedure or a     pharmaceutical or biopharmaceutical drug administration, a blood     transfusion, or other allogenic tissue or fluid administration; -   (m) A phosphonate compound of Table 2 or Table 3 or a compound that     is prepared from or consists of moieties in FIG. 1B, 1C, 2B, 2C, 2D,     2E, 3B, 3C, 3D, 3E, 3F, 3G, 3H, 3I, 3J, 3K, 3L, 3M, 3N, 6A, 6B or 8,     and optionally 4B, 4C, 4D, 4E or 4F, as described herein, and     pharmaceutically acceptable salts and prodrugs thereof, for use in     treating a medical disorder which is an inflammatory or immune     condition, a disorder mediated by the complement cascade (including     a dysfunctional cascade), a disorder or abnormality of a cell that     adversely affects the ability of the cell to engage in or respond to     normal complement activity, or an undesired complement-mediated     response to a medical treatment, such as surgery or other medical     procedure or a pharmaceutical or biopharmaceutical drug     administration, a blood transfusion, or other allogenic tissue or     fluid administration; -   (n) A phosphonate compound that is prepared from or consists of     moieties selected from FIG. 1D or 1E; 5; 6A or 6B; 7A, 7B, 7C, 7D or     7E; and 8; optionally including a moiety of FIG. 4A, 4B, 4C, 4D, 4E,     4F or 4G, as described herein, and pharmaceutically acceptable salts     and prodrugs thereof, for use in treating or preventing a disorder     listed in the Detailed Description, Part IV, Section A, including     but not limited to the development of fatty liver and conditions     stemming from fatty liver, such as nonalcoholic steatohepatitis     (NASH), liver inflammation, cirrhosis, liver failure;     dermatomyocitis; amyotrophic lateral sclerosis; and cytokine or     inflammatory reactions in response to biotherapeutics (e.g. CAR     T-cell therapy); -   (o) A phosphonate compound that is prepared from or consists of     moieties selected from one of the following groups: (i) any of FIG.     1B, 1C, 1D or 1E; FIG. 5; FIGS. 6A and 6B; and FIG. 7F; optionally     including a moiety of FIG. 4A, 4B, 4C, 4D, 4E, 4F or 4G; (ii) FIG.     1A, 1B, 1C, 1D, 1E, 33A, 3B, 3C, 3D, 3E, 3F, 3G, 3H, 3I, 3J, 3K, 3L,     3M, 3N, 3O, 3P or 3Q, 6A, 6B, and 7F, optionally 4A, 4B, 4C, 4D, 4E,     4F, or 4G; (iii) FIG. 1A, 1B, 1C, 1D, 1E, 33A, 3B, 3C, 3D, 3E, 3F,     3G, 3H, 3I, 3J, 3K, 3L, 3M, 3N, 3O, 3P or 3Q, 6A, 6B, and 7G,     optionally 4A, 4B, 4C, 4D, 4E, 4F, or 4G; or (iv) FIGS. 9A, 9B, 9C,     9D, 9E, 9F, 9G, 9H and any one of FIGS. 6A and B; as described     herein, and pharmaceutically acceptable salts and prodrugs thereof,     for use in treating or preventing a disorder listed in the Detailed     Description, Part IV, Section A, including but not limited to the     development of fatty liver and conditions stemming from fatty liver,     such as nonalcoholic steatohepatitis (NASH), liver inflammation,     cirrhosis, liver failure, dermatomyocitis; amyotrophic lateral     sclerosis; and cytokine or inflammatory reactions in response to the     administration of biotherapeutics (e.g. CAR T-cell therapy); -   (p) A phosphonate compound that is prepared from or consists of     moieties selected from one of the following groups: (i) any of FIG.     1B, 1C, 1D or 1E; FIG. 5; FIGS. 6A and 6B; and FIG. 7F; optionally     including a moiety of FIG. 4A, 4B, 4C, 4D, 4E, 4F or 4G; (ii) FIG.     1A, 1B, 1C, 1D, 1E, 33A, 3B, 3C, 3D, 3E, 3F, 3G, 3H, 3I, 3J, 3K, 3L,     3M, 3N, 3O, 3P or 3Q, 6A, 6B, and 7F, optionally 4A, 4B, 4C, 4D, 4E,     4F, or 4G; (iii) 1A, 1B, 1C, 1D, 1E, 33A, 3B, 3C, 3D, 3E, 3F, 3G,     3H, 3I, 3J, 3K, 3L, 3M, 3N, 3O, 3P or 3Q, 6A, 6B, and 7G, optionally     4A, 4B, 4C, 4D, 4E, 4F, or 4G; or (iv) FIGS. 9A, 9B, 9C, 9D, 9E, 9F,     9G, 9H and any one of FIGS. 6A and B; as described herein, and     pharmaceutically acceptable salts and prodrugs thereof, for use in     treating or preventing a disorder listed in the Detailed     Description, Part IV, Section B of this invention, including but not     limited to paroxysmal nocturnal hemoglobinuria (PNH), C3     glomerulonephritis, rheumatoid arthritis, multiple sclerosis,     age-related macular degeneration (AMD), retinal degeneration, other     ophthalmic diseases (e.g., geographic atrophy), a respiratory     disease or a cardiovascular disease; -   (q) A pharmaceutically acceptable composition of a compound of any     species consisting of moieties selected from one of the following     groups: (i) any of FIG. 1B, 1C, 1D or 1E; FIG. 5; FIGS. 6A and 6B;     and FIG. 7F; optionally including a moiety of FIG. 4A, 4B, 4C, 4D,     4E, 4F or 4G; (ii) FIG. 1A, 1B, 1C, 1D, 1E, 33A, 3B, 3C, 3D, 3E, 3F,     3G, 3H, 3I, 3J, 3K, 3L, 3M, 3N, 3O, 3P or 3Q, 6A, 6B, and 7F,     optionally 4A, 4B, 4C, 4D, 4E, 4F, or 4G; (iii) 1A, 1B, 1C, 1D, 1E,     33A, 3B, 3C, 3D, 3E, 3F, 3G, 3H, 3I, 3J, 3K, 3L, 3M, 3N, 3O, 3P or     3Q, 6A, 6B, and 7G, optionally 4A, 4B, 4C, 4D, 4E, 4F, or 4G;     or (iv) FIGS. 9A, 9B, 9C, 9D, 9E, 9F, 9G, 9H and any one of FIGS. 6A     and B; or its pharmaceutically acceptable salt in a pharmaceutically     acceptable carrier; -   (r) A compound that is prepared from or consists of moieties     selected from one of the following groups (i) any of FIG. 1B, 1C, 1D     or 1E; FIG. 5; any one of FIGS. 6A and 6B and FIG. 7F, optionally     including a moiety of FIG. 4A, 4B, 4C, 4D, 4E, 4F or 4G; or (ii)     FIG. 1B, 1C, 1D or 1E, 3B, 3C, 3D, 3E, 3F, 3G, 3H, 3I, 3J, 3K, 3L,     3M, 3N, 3O, 3P or 3Q, 6A, 6B and 7F, optionally including a moiety     of FIG. 4A, 4B, 4C, 4D, 4E, 4F or 4G; as described herein, and     pharmaceutically acceptable salts, prodrugs and pharmaceutically     acceptable compositions thereof; -   (s) A compound that is prepared from or consists of moieties     selected from one of the following groups (i) any of FIG. 1B, 1C, 1D     or 1E; FIG. 5; any one of FIGS. 6A and 6B and FIG. 7F; optionally     including a moiety of FIG. 4A, 4B, 4C, 4D, 4E, 4F or 4G; (ii) FIG.     1B, 1C, 1D or 1E, 3B, 3C, 3D, 3E, 3F, 3G, 3H, 3I, 3J, 3K, 3L, 3M,     3N, 3O, 3P or 3Q, 6A, 6B and 7F, optionally including a moiety of     FIG. 4A, 4B, 4C, 4D, 4E, 4F or 4G; or (iii) FIG. 1B, 1C, 1D or 1E,     3B, 3C, 3D, 3E, 3F, 3G, 3H, 3I, 3J, 3K, 3L, 3M, 3N, 3O, 3P or 3Q,     6A, 6B and 7G, optionally including a moiety of FIG. 4A, 4B, 4C, 4D,     4E, 4F or 4G; as described herein, and pharmaceutically acceptable     salts and prodrugs thereof, for use in treating or preventing     disorders mediated by the complement pathway, and for example,     cascade Factor D; -   (t) Use of a compound that is prepared from or consists of moieties     selected from FIG. 1D or 1E; 5; 6A or 6B; 7A, 7B, 7C, 7D or 7E; and     8; optionally including a moiety of FIG. 4A, 4B, 4C, 4D, 4E, 4F or     4G as described herein, and pharmaceutically acceptable salts and     prodrugs thereof, in the manufacture of a medicament for treating or     preventing a disorder listed in the Detailed Description, Part IV,     Section A, including but not limited to the development of fatty     liver and conditions stemming from fatty liver, such as nonalcoholic     steatohepatitis (NASH), liver inflammation, cirrhosis, liver     failure; dermatomyocitis; amyotrophic lateral sclerosis; and     cytokine or inflammatory reactions in response to biotherapeutics     (e.g. CAR T-cell therapy); -   (u) Use of a compound of that is prepared from or consists of     moieties selected from (i) any of FIG. 1B, 1C, 1D or 1E; FIG. 5; any     one of FIGS. 6A and 6B; and FIG. 7F; optionally including a moiety     of FIG. 4A, 4B, 4C, 4D, 4E, 4F or 4G (ii) FIG. 1B, 1C, 1D or 1E, 3B,     3C, 3D, 3E, 3F, 3G, 3H, 3I, 3J, 3K, 3L, 3M, 3N, 3O, 3P or 3Q, 6A, 6B     and 7F, optionally including a moiety of FIG. 4A, 4B, 4C, 4D, 4E, 4F     or 4G; or (iii) FIG. 1B, 1C, 1D or 1E, 3B, 3C, 3D, 3E, 3F, 3G, 3H,     3I, 3J, 3K, 3L, 3M, 3N, 3O, 3P or 3Q, 6A, 6B and 7G, optionally     including a moiety of FIG. 4A, 4B, 4C, 4D, 4E, 4F or 4G; as     described herein, and pharmaceutically acceptable salts and prodrugs     thereof, in the manufacture of a medicament for treating or     preventing a disorder listed in the Detailed Description, Part IV,     Section A, including but not limited to the development of fatty     liver and conditions stemming from fatty liver, such as nonalcoholic     steatohepatitis (NASH), liver inflammation, cirrhosis, liver     failure; dermatomyocitis; amyotrophic lateral sclerosis; and     cytokine or inflammatory reactions in response to biotherapeutics     (e.g. CAR T-cell therapy); -   (v) Use of a compound that is prepared from or consists of moieties     selected from (i) any of FIG. 1B, 1C, 1D or 1E; FIG. 5; any one of     FIGS. 6A-E and FIG. 7F; optionally including a moiety of FIG. 4 (ii)     FIG. 1B, 1C, 1D or 1E, 3B, 3C, 3D, 3E, 3F, 3G, 3H, 3I, 3J, 3K, 3L,     3M, 3N, 3O, 3P or 3Q, 6A, 6B and 7F, optionally including a moiety     of FIG. 4A, 4B, 4C, 4D, 4E, 4F or 4G; or (iii) FIG. 1B, 1C, 1D or     1E, 3B, 3C, 3D, 3E, 3F, 3G, 3H, 3I, 3J, 3K, 3L, 3M, 3N, 3O, 3P or     3Q, 6A, 6B and 7G, optionally including a moiety of FIG. 4A, 4B, 4C,     4D, 4E, 4F or 4G as described herein, and pharmaceutically     acceptable salts and prodrugs thereof, in the manufacture of a     medicament for treating or preventing a disorder listed in the     Detailed Description, Part IV, Section B of this invention,     including but not limited to paroxysmal nocturnal hemoglobinuria     (PNH), C3 glomerulonephritis, rheumatoid arthritis, multiple     sclerosis, age-related macular degeneration (AMD), retinal     degeneration, other ophthalmic diseases (e.g., geographic atrophy),     a respiratory disease or a cardiovascular disease; -   (w) A process for manufacturing a medicament intended for the     therapeutic use for treating or preventing a disorder listed in the     Detailed Description, Part IV, Section A or Section B, or generally     for treating or preventing disorders mediated by complement cascade     Factor D, including age-related macular degeneration (AMD), retinal     degeneration, paroxysymal nocturnal hemoglobinuria (PNH), C3     glomerulonephritis, multiple sclerosis (MS), and rheumatoid     arthritis (RA) and other disorders described further herein     characterized in that a compound selected for use is a compound that     is prepared from or consists of moieties selected from (i) any of     FIG. 1B, 1C, 1D or 1E; FIG. 5; any one of FIGS. 6A and 6B and FIG.     7F; optionally including a moiety of FIG. 4A, 4B, 4C, 4D, 4E, 4F, or     4G (ii) FIG. 1B, 1C, 1D or 1E, 3B, 3C, 3D, 3E, 3F, 3G, 3H, 3I, 3J,     3K, 3L, 3M, 3N, 3O, 3P or 3Q, 6A, 6B and 7F, optionally including a     moiety of FIG. 4A, 4B, 4C, 4D, 4E, 4F or 4G (iii) 1B, 1C, 1D or 1E,     3B, 3C, 3D, 3E, 3F, 3G, 3H, 3I, 3J, 3K, 3L, 3M, 3N, 3O, 3P or 3Q,     6A, 6B and 7G, optionally including a moiety of FIG. 4A, 4B, 4C, 4D,     4E, 4F or 4G as described herein is used in the manufacture; -   (x) A compound that is prepared from or consists of moieties     selected from (i) any of FIG. 1B, 1C, 1D or 1E; FIG. 5; any one of     FIGS. 6A and 6B, and FIG. 7F; optionally including a moiety of FIG.     4A, 4B, 4C, 4D, 4E, 4F or 4G (ii) FIG. 1B, 1C, 1D or 1E, 3B, 3C, 3D,     3E, 3F, 3G, 3H, 3I, 3J, 3K, 3L, 3M, 3N, 3O, 3P or 3Q, 6A, 6B and 7F,     optionally including a moiety of FIG. 4A, 4B, 4C, 4D, 4E, 4F or 4G     as described herein as described herein in substantially pure form     (e.g., at least 90 or 95%); -   (y) A compound that is prepared from or consists of moieties     selected from FIG. 1D or 1E; 5; 6A or 6B; 7A, 7B, 7C, 7D or 7E; and     8; optionally including a moiety of FIG. 4A, 4B, 4C, 4D, 4E, 4F or     4G; as described herein, and pharmaceutically acceptable salts and     prodrugs thereof, for use in treating a medical disorder which is an     inflammatory or immune condition, a disorder mediated by the     complement cascade (including a dysfunctional cascade), a disorder     or abnormality of a cell that adversely affects the ability of the     cell to engage in or respond to normal complement activity, or an     undesired complement-mediated response to a medical treatment, such     as surgery or other medical procedure or a pharmaceutical or     biopharmaceutical drug administration, a blood transfusion, or other     allogenic tissue or fluid administration; and -   (z) A compound that is prepared from or consists of moieties     selected from (i) any of FIG. 1B, 1C, 1D or 1E; FIG. 5; any one of     FIGS. 6A and 6B and FIG. 7F; optionally including a moiety of FIG.     4A, 4B, 4C, 4D, 4E, 4F or 4G (ii) FIG. 1B, 1C, 1D or 1E, 3B, 3C, 3D,     3E, 3F, 3G, 3H, 3I, 3J, 3K, 3L, 3M, 3N, 3O, 3P or 3Q, 6A, 6B and 7F,     optionally including a moiety of FIG. 4A, 4B, 4C, 4D, 4E, 4F or 4G;     or (iii) FIG. 1B, 1C, 1D or 1E, 3B, 3C, 3D, 3E, 3F, 3G, 3H, 3I, 3J,     3K, 3L, 3M, 3N, 3O, 3P or 3Q, 6A, 6B and 7G, optionally including a     moiety of FIG. 4A, 4B, 4C, 4D, 4E, 4F or 4G; and pharmaceutically     acceptable salts and prodrugs thereof, for use in treating a medical     disorder which is an inflammatory or immune condition, a disorder     mediated by the complement cascade (including a dysfunctional     cascade), a disorder or abnormality of a cell that adversely affects     the ability of the cell to engage in or respond to normal complement     activity, or an undesired complement-mediated response to a medical     treatment, such as surgery or other medical procedure or a     pharmaceutical or biopharmaceutical drug administration, a blood     transfusion, or other allogenic tissue or fluid administration. -   (aa) For each of (a) through (z) above, and otherwise herein, each     assembly of moieties in the Figures and each active compound made     therefrom or its use is considered and deemed specifically and     individually disclosed, as such depiction is for convenience of     space only and not intended to describe a only a genus or even a     subgenus for such indication. -   (bb) In another embodiment, any moiety of “A” (FIG. 1 B, C, D or E);     any moiety of “B” ((FIG. 2 B, C, D, or E), FIG. 7 (A, B, C, D, E, F     or G) or FIG. 8); any moiety of the core ((FIG. 3 B, C, D, E, F, G,     H, I, J, K, L, M, N, P or Q) or FIG. 5), any moiety of Linker (FIG.     4 B, C, D, E, F, or G) and any moiety of R³² (FIG. 6A or B) can be     combined to treat an indication of Section A; and the assembly of     moieties from the Figures and each active compound made therefrom is     considered and deemed specifically and individually disclosed, as     such depiction is for convenience of space only and not intended to     describe a only a genus or even a subgenus for such indication; -   (cc) In another embodiment, any moiety of “A” (FIG. 1 B, C, D, E, or     F); any moiety of “B” ((FIG. 2 B, C, D, or E), FIG. 7 (A, B, C, D,     E, F or G) or FIG. 8); any moiety of the core ((FIG. 3 B, C, D, E,     F, G, H, I, J, K, L, M, N, P or Q) or FIG. 5), any moiety of Linker     (FIG. 4 B, C, D, E, F, or G) and any moiety of R³² (FIG. 6 A or B)     can be combined to treat an indication of Section B with the proviso     that there is at least one moiety selected from FIG. 1 (B, C, or F);     or FIG. 7F; or FIG. 4F; and the assembly of moieties from the     Figures and each active compound made therefrom is considered and     deemed specifically and individually disclosed, as such depiction is     for convenience of space only and not intended to describe a only a     genus or even a subgenus for such indication.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1A is an illustration of Formula I which highlights the location of the A ring.

FIGS. 1B and 1C provide non-limiting embodiments of the A ring, wherein R³² is defined below.

FIGS. 1D, 1E and 1F illustrate non-limiting embodiments of the A ring of FIG. 1A, wherein R⁴, R⁵, R⁶, R⁷, R⁸, R^(8′), R¹¹, R¹², R¹³, R¹⁴, R¹⁵, R¹⁶, R¹⁹, R³², X¹¹, X¹², X¹³, and X¹⁴ are defined below.

FIG. 2A illustrates the location of the B ring of Formula I.

FIGS. 2B, 2C, 2D and 2E provide certain embodiments of the B ring, wherein “halo” can be F, Cl, Br, or I.

FIG. 3A illustrates the location of the Central Core of Formula I.

FIGS. 3B, 3C, 3D, 3E, 3F, 3G, 3H, 3I, 3J, 3K, 3L, 3M, 3N, 3O, 3P, and 3Q provide non-limiting embodiments of the Central Core ring (C ring), wherein q is 0, 1, 2 or 3, r is 1, 2 or 3,

is a single or double bond, and R⁴⁴, R^(44′), R⁴⁵, R^(45′) are defined below wherein each group can be optionally substituted.

FIG. 4A illustrates the location of the Linker in Formula I.

FIGS. 4B, 4C, 4D, 4E, 4F and 4G, provide non-limiting specific embodiments of the Linker (L), wherein R¹⁷, R¹⁸, R^(18′), and m are defined below.

FIG. 5 provides non-limiting specific embodiments of the Central Core ring, wherein R, R′, and R³ are defined below.

FIGS. 6A and 6B provide non-limiting specific embodiments of R³², wherein R¹⁰⁰ is defined below.

FIGS. 7A, 7B, 7C, 7D, 7E, 7F and 7G provide non-limiting specific embodiments of the B ring, wherein R²⁷, R²⁸, and R²⁹ are defined below.

FIG. 8 provides non-limiting specific embodiments of the B ring.

FIGS. 9A, 9B, 9C, 9D, 9E, 9F, 9G and 9H provide non-limiting examples of compounds included in the present invention, wherein Z₃₂ is the same as R³² as used herein.

DETAILED DESCRIPTION I. Terminology

Compounds are described using standard nomenclature. Unless defined otherwise, all technical and scientific terms used herein have the same meaning as is commonly understood by one of skill in the art to which this invention belongs.

The compounds in any of the Formulas described herein include enantiomers, mixture of enantiomers, diasteromers, tautomers, racemates and other isomers, such as rotamers, as if each is specifically described, unless otherwise indicated in the text or drawing or otherwise indicated in context.

“Formula I” includes all subgeneric groups of Formula I, such as Formula IA and Formula IB and also includes pharmaceutically acceptable salts of a compound of Formula I, unless clearly contraindicated by the context in which this phrase is used. “Formula I” also includes all subgeneric groups of Formula I, such as Formulas IC-ID, and Formulas II-XXX, and also includes pharmaceutically acceptable salts of all subgeneric groups of Formula I, such as Formulas IA-ID, and Formulas II-XXX, unless contraindicated by the context in which this phrase is used.

The terms “a” and “an” do not denote a limitation of quantity, but rather denote the presence of at least one of the referenced item. The term “or” means “and/or”. Recitation of ranges of values are merely intended to serve as a shorthand method of referring individually to each separate value falling within the range, unless otherwise indicated herein, and each separate value is incorporated into the specification as if it were individually recited herein. The endpoints of all ranges are included within the range and independently combinable. All methods described herein can be performed in a suitable order unless otherwise indicated herein or otherwise clearly contradicted by context. The use of examples, or exemplary language (e.g., “such as”), is intended merely to better illustrate the invention and does not pose a limitation on the scope of the invention unless otherwise claimed. Unless defined otherwise, technical and scientific terms used herein have the same meaning as is commonly understood by one of skill in the art to which this invention belongs.

The present invention includes an embodiment of the active compound as described in the Figures and the use of compounds of Formula I, Table 1, or an embodiment of the active compound as described in the Figures with at least one desired isotopic substitution of an atom, at an amount above the natural abundance of the isotope, i.e., enriched. Isotopes are atoms having the same atomic number but different mass numbers, i.e., the same number of protons but a different number of neutrons.

Examples of isotopes that can be incorporated into compounds of the invention include isotopes of hydrogen, carbon, nitrogen, oxygen, phosphorous, fluorine, and chlorine, such as ²H, ³H, ¹¹C, ¹³C, ¹⁴C, ¹⁵N, ¹⁸F ³¹P, ³²P, ³⁵S, ³⁶CI, ¹²⁵I respectively. In one embodiment, isotopically labelled compounds can be used in metabolic studies (with ¹⁴C), reaction kinetic studies (with, for example ²H or ³H), detection or imaging techniques, such as positron emission tomography (PET) or single-photon emission computed tomography (SPECT) including drug or substrate tissue distribution assays, or in radioactive treatment of patients. In particular, an ¹⁸F labeled compound may be particularly desirable for PET or SPECT studies. Isotopically labeled compounds of this invention and prodrugs thereof can generally be prepared by carrying out the procedures disclosed in the schemes or in the examples and preparations described below by substituting a readily available isotopically labeled reagent for a non-isotopically labeled reagent.

By way of general example and without limitation, isotopes of hydrogen, for example, deuterium (²H) and tritium (³H) may be used anywhere in described structures that achieves the desired result. Alternatively or in addition, isotopes of carbon, e.g., ¹³C and ¹⁴C, may be used. In one embodiment, the isotopic substitution is deuterium for hydrogen at one or more locations on the molecule to improve the performance of the drug, for example, the pharmacodynamics, pharmacokinetics, biodistribution, half-life, stability, AUC, Tmax, Cmax, etc. For example, the deuterium can be bound to carbon in a location of bond breakage during metabolism (an α-deuterium kinetic isotope effect) or next to or near the site of bond breakage (a β-deuterium kinetic isotope effect).

Isotopic substitutions, for example deuterium substitutions, can be partial or complete. Partial deuterium substitution means that at least one hydrogen is substituted with deuterium. In certain embodiments, the isotope is 90, 95 or 99% or more enriched in an isotope at any location of interest. In one embodiments deuterium is 90, 95 or 99% enriched at a desired location. Unless otherwise stated, the enrichment at any point is above natural abundance and enough to alter a detectable property of the drug in a human.

In one embodiment, the substitution of a hydrogen atom for a deuterium atom can be provided in any of A, B, L, or central core. In one embodiment, the substitution of a hydrogen atom for a deuterium atom occurs within an R group selected from any of R, R′, R¹, R^(1′), R², R^(2′), R³, R^(3′), R⁴, R⁵, R⁶, R^(6′), R⁷, R⁸, R^(8′), R⁹, R¹⁰, R¹¹, R¹², R¹³, R¹⁴, R¹⁵, R¹⁶, R¹⁷, R¹⁸, R^(18′), R¹⁹, R²⁰, R²¹, R²², R²³, R²⁴, R²⁵, R²⁶, R²⁷, R²⁸, R²⁹, R³¹, R³², R³³, R³⁴, R³⁵, R³⁶, R⁷⁵, R¹⁰¹, R¹⁰², R¹⁰⁵, R¹⁰⁶, and R¹⁰⁷. For example, when any of R groups are, or contain for example through substitution, methyl, ethyl, or methoxy, the alkyl residue may be deuterated (in non-limiting embodiments, CD₃, CH₂CD₃, CD₂CD₃, CDH₂, CD₂H, CD₃, CHDCH₂D, CH₂CD₃, CHDCHD₂, OCDH₂, OCD₂H, or OCD₃ etc.). In certain other embodiments, when two substituents of the central core ring are combined to form a cyclopropyl ring, the unsubstituted methylene carbon may be deuterated.

The substitution of a hydrogen atom for a deuterium atom occurs within an R group when at least one of the variables within the R group is hydrogen (e.g., ²H or D) or alkyl. For example, when any of R groups are, or contain for example through substitution, methyl or ethyl, the alkyl residue may be deuterated (in non-limiting embodiments, CD₃, CH₂CD₃, CD₂CD₃, CDH₂, CD₂H, CD₃, CHDCH₂D, CH₂CD₃, CHDCHD₂, etc.).

The compound of the present invention may form a solvate with solvents (including water). Therefore, in one embodiment, the invention includes a solvated form of the active compound. The term “solvate” refers to a molecular complex of a compound of the present invention (including a salt thereof) with one or more solvent molecules. Non-limiting examples of solvents are water, ethanol, dimethyl sulfoxide, acetone and other common organic solvents. The term “hydrate” refers to a molecular complex comprising a compound of the invention and water. Pharmaceutically acceptable solvates in accordance with the invention include those wherein the solvent of crystallization may be isotopically substituted, e.g. D₂O, d₆-acetone, d₆-DMSO. A solvate can be in a liquid or solid form.

A dash (“-”) that is not between two letters or symbols is used to indicate a point of attachment for a substituent. For example, —(C═O)NH₂ is attached through carbon of the keto (C═O) group.

The term “substituted”, as used herein, means that any one or more hydrogens on the designated atom or group is replaced with a moiety selected from the indicated group, provided that the designated atom's normal valence is not exceeded and the resulting compound is stable. For example, when the substituent is oxo (i.e., ═O) then two hydrogens on the atom are replaced. For example a pyridyl group substituted by oxo is a pyridone. Combinations of substituents and/or variables are permissible only if such combinations result in stable compounds or useful synthetic intermediates.

A stable active compound refers to a compound that can be isolated and can be formulated into a dosage form with a shelf life of at least one month. A stable manufacturing intermediate or precursor to an active compound is stable if it does not degrade within the period needed for reaction or other use. A stable moiety or substituent group is one that does not degrade, react or fall apart within the period necessary for use. Non-limiting examples of unstable moieties are those that combine heteroatoms in an unstable arrangement, as typically known and identifiable to those of skill in the art.

Any suitable group may be present on a “substituted” or “optionally substituted” position that forms a stable molecule and meets the desired purpose of the invention and includes, but is not limited to, e.g., halogen (which can independently be F, Cl, Br or I); cyano; hydroxyl; nitro; azido; alkanoyl (such as a C₂-C₆ alkanoyl group); carboxamide; alkyl, cycloalkyl, alkenyl, alkynyl, alkoxy, aryloxy such as phenoxy; alkylthio including those having one or more thioether linkages; alkylsulfinyl; alkylsulfonyl groups including those having one or more sulfonyl linkages; aminoalkyl groups including groups having one or more N atoms; aryl (e.g., phenyl, biphenyl, naphthyl, or the like, each ring either substituted or unsubstituted aromatic); arylalkyl having for example, 1 to 3 separate or fused rings and from 6 to about 14 or 18 ring carbon atoms, with benzyl being an exemplary arylalkyl group; arylalkoxy, for example, having 1 to 3 separate or fused rings with benzyloxy being an exemplary arylalkoxy group; or a saturated, unsaturated, or aromatic heterocyclic group having 1 to 3 separate or fused rings with one or more N, O or S atoms, e.g. coumarinyl, quinolinyl, isoquinolinyl, quinazolinyl, pyridyl, pyrazinyl, pyrimidinyl, furanyl, pyrrolyl, thienyl, thiazolyl, triazinyl, oxazolyl, isoxazolyl, imidazolyl, indolyl, benzofuranyl, benzothiazolyl, tetrahydrofuranyl, tetrahydropyranyl, piperidinyl, morpholinyl, piperazinyl, and pyrrolidinyl. Such heterocyclic groups may be further substituted, e.g. with hydroxy, alkyl, alkoxy, halogen and amino. In certain embodiments “optionally substituted” includes one or more substituents independently selected from halogen, hydroxyl, amino, cyano, —CHO, —COOH, —CONH₂, C₁-C₆alkyl, C₂-C₆alkenyl, C₂-C₆alkynyl, —C₁-C₆alkoxy, C₂-C₆alkanoyl, C₁-C₆alkylester, (mono- and di-C₁-C₆alkylamino)C₀-C₂alkyl, C₁-C₂haloalkyl, hydoxyC₁-C₆alkyl, ester, carbamate, urea, sulfonamide, —C₁-C₆alkyl(heterocyclo), C₁-C₆alkyl(heteroaryl), —C₁-C₆alkyl(C₃-C₇cycloalkyl), O—C₁-C₆alkyl(C₃-C₇cycloalkyl), B(OH)₂, phosphate, phosphonate and C₁-C₂haloalkoxy.

“Alkyl” is a branched or straight chain saturated aliphatic hydrocarbon group. In one embodiment, the alkyl contains from 1 to about 12 carbon atoms, more generally from 1 to about 6 carbon atoms or from 1 to about 4 carbon atoms. In one embodiment, the alkyl contains from 1 to about 8 carbon atoms. In certain embodiments, the alkyl is C₁-C₂, C₁-C₃, or C₁-C₆. The specified ranges as used herein indicate an alkyl group having each member of the range described as an independent species. For example, the term C₁-C₆ alkyl as used herein indicates a straight or branched alkyl group having from 1, 2, 3, 4, 5, or 6 carbon atoms and is intended to mean that each of these is described as an independent species. For example, the term C₁-C₄alkyl as used herein indicates a straight or branched alkyl group having from 1, 2, 3, or 4 carbon atoms and is intended to mean that each of these is described as an independent species. When C₀-C_(n) alkyl is used herein in conjunction with another group, for example, (C₃-C₇cycloalkyl)C₀-C₄ alkyl, or —C₀-C₄alkyl(C₃-C₇cycloalkyl), the indicated group, in this case cycloalkyl, is either directly bound by a single covalent bond (Coalkyl), or attached by an alkyl chain in this case 1, 2, 3, or 4 carbon atoms. Alkyls can also be attached via other groups such as heteroatoms as in —O—C₀-C₄alkyl(C₃-C₇cycloalkyl). Examples of alkyl include, but are not limited to, methyl, ethyl, n-propyl, isopropyl, n-butyl, isobutyl, sec-butyl, t-butyl, n-pentyl, isopentyl, tert-pentyl, neopentyl, n-hexyl, 2-methylpentane, 3-methylpentane, 2,2-dimethylbutane, 2,3-dimethylbutane, and hexyl. In one embodiment, the alkyl group is optionally substituted as described above.

In one embodiment, when a term is used that includes “alk” it should be understood that “cycloalkyl” or “carbocyclic” can be considered part of the definition, unless unambiguously excluded by the context. For example and without limitation, the terms alkyl, alkenyl, alkynyl, alkoxy, alkanoyl, alkenloxy, haloalkyl, aminoalkyl, alkylene, alkenylene, alkynylene, etc. can all be considered to include the cyclic forms of alkyl, unless unambiguously excluded by context.

“Alkenyl” is a branched or straight chain aliphatic hydrocarbon group having one or more carbon-carbon double bonds that may occur at a stable point along the chain. Non-limiting examples are C₂-C₈alkenyl, C₂-C₆alkenyl and C₂-C₄alkenyl. The specified ranges as used herein indicate an alkenyl group having each member of the range described as an independent species, as described above for the alkyl moiety. Examples of alkenyl include, but are not limited to, ethenyl and propenyl. In one embodiment, the alkenyl group is optionally substituted as described above.

“Alkynyl” is a branched or straight chain aliphatic hydrocarbon group having one or more carbon-carbon triple bonds that may occur at any stable point along the chain, for example, C₂-C₈alkynyl or C₂-C₆alkynyl. The specified ranges as used herein indicate an alkynyl group having each member of the range described as an independent species, as described above for the alkyl moiety. Examples of alkynyl include, but are not limited to, ethynyl, propynyl, 1-butynyl, 2-butynyl, 3-butynyl, 1-pentynyl, 2-pentynyl, 3-pentynyl, 4-pentynyl, 1-hexynyl, 2-hexynyl, 3-hexynyl, 4-hexynyl and 5-hexynyl. In one embodiment, the alkynyl group is optionally substituted as described above.

“Alkylene” is a bivalent saturated hydrocarbon. Alkylenes, for example, can be a 1 to 8 carbon moiety, 1 to 6 carbon moiety, or an indicated number of carbon atoms, for example C₁-C₄alkylene, C₁-C₃alkylene, or C₁-C₂alkylene.

“Alkenylene” is a bivalent hydrocarbon having at least one carbon-carbon double bond. Alkenylenes, for example, can be a 2 to 8 carbon moiety, 2 to 6 carbon moiety, or an indicated number of carbon atoms, for example C₂-C₄alkenylene.

“Alkynylene” is a bivalent hydrocarbon having at least one carbon-carbon triple bond. Alkynylenes, for example, can be a 2 to 8 carbon moiety, 2 to 6 carbon moiety, or an indicated number of carbon atoms, for example C₂-C₄alkynylene.

“Alkoxy” is an alkyl group as defined above covalently bound through an oxygen bridge (—O—). Examples of alkoxy include, but are not limited to, methoxy, ethoxy, n-propoxy, i-propoxy, n-butoxy, 2-butoxy, t-butoxy, n-pentoxy, 2-pentoxy, 3-pentoxy, isopentoxy, neopentoxy, n-hexoxy, 2-hexoxy, 3-hexoxy, and 3-methylpentoxy. Similarly an “alkylthio” or a “thioalkyl” group is an alkyl group as defined above with the indicated number of carbon atoms covalently bound through a sulfur bridge (—S—). In one embodiment, the alkoxy group is optionally substituted as described above.

“Alkenyloxy” is an alkenyl group as defined covalently bound to the group it substitutes by an oxygen bridge (—O—).

“Alkanoyl” is an alkyl group as defined above covalently bound through a carbonyl (C═O) bridge. The carbonyl carbon is included in the number of carbons, that is C₂alkanoyl is a CH₃(C═O)— group. In one embodiment, the alkanoyl group is optionally substituted as described above.

“Alkylester” is an alkyl group as defined herein covalently bound through an ester linkage. The ester linkage may be in either orientation, e.g., a group of the formula —O(C═O)alkyl or a group of the formula —(C═O)Oalkyl.

“Amide” or “carboxamide” is —C(O)NR^(a)R^(b) wherein R^(a) and R^(b) are each independently selected from hydrogen, alkyl, for example, C₁-C₆alkyl, alkenyl, for example, C₂-C₆alkenyl, alkynyl, for example, C₂-C₆alkynyl, —C₀-C₄alkyl(C₃-C₇cycloalkyl), —C₀-C₄alkyl(C₃-C₇heterocycloalkyl), —C₀-C₄alkyl(aryl), and —C₀-C₄alkyl(heteroaryl); or together with the nitrogen to which they are bonded, R^(a) and R^(b) can form a C₃-C₇heterocyclic ring. In one embodiment, the R^(a) and R^(b) groups are each independently optionally substituted as described above.

“Carbocyclic group”, “carbocyclic ring”, or “cycloalkyl” is a saturated or partially unsaturated (i.e., not aromatic) group containing all carbon ring atoms. A carbocyclic group typically contains 1 ring of 3 to 7 carbon atoms or 2 fused rings each containing 3 to 7 carbon atoms. Cycloalkyl substituents may be pendant from a substituted nitrogen or carbon atom, or a substituted carbon atom that may have two substituents can have a cycloalkyl group, which is attached as a spiro group. Examples of carbocyclic rings include cyclohexenyl, cyclohexyl, cyclopentenyl, cyclopentyl, cyclobutenyl, cyclobutyl and cyclopropyl rings. In one embodiment, the carbocyclic ring is optionally substituted as described above. In one embodiment, the cycloalkyl is a partially unsaturated (i.e., not aromatic) group containing all carbon ring atoms. In another embodiment, the cycloalkyl is a saturated group containing all carbon ring atoms.

“Carbocyclic-oxy group” is a monocyclic carbocyclic ring or a mono- or bi-cyclic carbocyclic group as defined above attached to the group it substitutes via an oxygen, —O—, linker.

“Haloalkyl” indicates both branched and straight-chain alkyl groups substituted with 1 or more halogen atoms, up to the maximum allowable number of halogen atoms. Examples of haloalkyl include, but are not limited to, trifluoromethyl, monofluoromethyl, difluoromethyl, 2-fluoroethyl, and penta-fluoroethyl.

“Haloalkoxy” indicates a haloalkyl group as defined herein attached through an oxygen bridge (oxygen of an alcohol radical).

“Hydroxyalkyl” is an alkyl group as previously described, substituted with at least one hydroxyl subsitutuent.

“Aminoalkyl” is an alkyl group as previously described, substituted with at least one amino subsitutuent.

“Halo” or “halogen” indicates independently any of fluoro, chloro, bromo or iodo.

“Aryl” indicates an aromatic group containing only carbon in the aromatic ring or rings. In one embodiment, the aryl groups contain 1 to 3 separate or fused rings and is 6 to about 14 or 18 ring atoms, without heteroatoms as ring members. When indicated, such aryl groups may be further substituted with carbon or non-carbon atoms or groups. Such substitution may include fusion to a 4 to 7 or a 5 to 7-membered saturated or partially unsaturated cyclic group that optionally contains 1, 2 or 3 heteroatoms independently selected from N, O, B, P, Si and/or S, to form, for example, a 3,4-methylenedioxyphenyl group. Aryl groups include, for example, phenyl and naphthyl, including 1-naphthyl and 2-naphthyl. In one embodiment, aryl groups are pendant. An example of a pendant ring is a phenyl group substituted with a phenyl group. In one embodiment, the aryl group is optionally substituted as described above.

The term “heterocycle,” or “heterocyclic ring” as used herein refers to a saturated or a partially unsaturated (i.e., having one or more double and/or triple bonds within the ring without aromaticity) carbocyclic moiety of 3 to about 12, and more typically 3, 5, 6, 7 to 10 ring atoms in which at least one ring atom is a heteroatom selected from nitrogen, oxygen, phosphorus and sulfur, the remaining ring atoms being C, where one or more ring atoms is optionally substituted independently with one or more substituents described above. A heterocycle may be a monocycle having 3 to 7 ring members (2 to 6 carbon atoms and 1 to 4 heteroatoms selected from N, O, P, and S) or a bicycle having 6 to 10 ring members (4 to 9 carbon atoms and 1 to 6 heteroatoms selected from N, O, P, and S), for example: a bicyclo [4,5], [5,5], [5,6], or [6,6] system. In one embodiment, the only heteroatom is nitrogen. In one embodiment, the only heteroatom is oxygen. In one embodiment, the only heteroatom is sulfur. Heterocycles are described in Paquette, Leo A.; “Principles of Modern Heterocyclic Chemistry” (W. A. Benjamin, New York, 1968), particularly Chapters 1, 3, 4, 6, 7, and 9; “The Chemistry of Heterocyclic Compounds, A series of Monographs” (John Wiley & Sons, New York, 1950 to present), in particular Volumes 13, 14, 16, 19, and 28; and J. Am. Chem. Soc. (1960) 82:5566. Examples of heterocyclic rings include, but are not limited to, pyrrolidinyl, dihydrofuranyl, tetrahydrothienyl, tetrahydropyranyl, dihydropyranyl, tetrahydrothiopyranyl, piperidino, piperidonyl, morpholino, thiomorpholino, thioxanyl, piperazinyl, homopiperazinyl, azetidinyl, oxetanyl, thietanyl, homopiperidinyl, oxepanyl, thiepanyl, oxazepinyl, diazepinyl, thiazepinyl, 2-pyrrolinyl, 3-pyrrolinyl, indolinyl, 2H-pyranyl, 4H-pyranyl, dioxanyl, 1,3-dioxolanyl, pyrazolinyl, dithianyl, dithiolanyl, dihydropyranyl, dihydrothienyl, dihydrofuranyl, dihydroisoquinolinyl, tetrahydroisoquinolinyl, pyrazolidinylimidazolinyl, imidazolidinyl, 2-oxa-5-azabicyclo[2.2.2]octane, 3-oxa-8-azabicyclo[3.2.1]octane, 8-oxa-3-azabicyclo[3.2.1]octane, 6-oxa-3-azabicyclo[3.1.1]heptane, 2-oxa-5-azabicyclo[2.2.1]heptane, 3-azabicyco[3.1.0]hexanyl, 3-azabicyclo[4.1.0]heptanyl, azabicyclo[2.2.2]hexanyl, 3H-indolyl, quinolizinyl, N-pyridyl ureas, and pyrrolopyrimidine. Spiro moieties are also included within the scope of this definition. Examples of a heterocyclic group wherein 1 or 2 ring carbon atoms are substituted with oxo (═O) moieties are pyrimidinonyl and 1,1-dioxo-thiomorpholinyl. The heterocycle groups herein are optionally substituted independently with one or more substituents described herein.

“Heterocyclicoxy group” is a monocyclic heterocyclic ring or a bicyclic heterocyclic group as described previously linked to the group it substitutes via an oxygen, —O—, linker.

“Heteroaryl” indicates a stable monocyclic aromatic ring which contains from 1 to 3, or in some embodiments from 1, 2 or 3 heteroatoms selected from N, O, S, B or P with remaining ring atoms being carbon, or a stable bicyclic or tricyclic system containing at least one 4 to 7 or 5 to 7 membered aromatic ring which contains from 1 to 3, or in some embodiments from 1 to 2, heteroatoms selected from N, O, S, B or P with remaining ring atoms being carbon. In one embodiment, the only heteroatom is nitrogen. In one embodiment, the only heteroatom is oxygen. In one embodiment, the only heteroatom is sulfur. Monocyclic heteroaryl groups typically have from 5 to 7 ring atoms. In some embodiments bicyclic heteroaryl groups are 8- to 10-membered heteroaryl groups, that is, groups containing 8 or 10 ring atoms in which one 5- to 7-member aromatic ring is fused to a second aromatic or non-aromatic ring. When the total number of S and O atoms in the heteroaryl group exceeds 1, these heteroatoms are not adjacent to one another. In one embodiment, the total number of S and O atoms in the heteroaryl group is not more than 2. In another embodiment, the total number of S and O atoms in the aromatic heterocycle is not more than 1. Examples of heteroaryl groups include, but are not limited to, pyridinyl (including, for example, 2-hydroxypyridinyl), imidazolyl, imidazopyridinyl, pyrimidinyl (including, for example, 4-hydroxypyrimidinyl), pyrazolyl, triazolyl, pyrazinyl, tetrazolyl, furyl, thienyl, isoxazolyl, thiazolyl, oxadiazolyl, oxazolyl, isothiazolyl, pyrrolyl, quinolinyl, isoquinolinyl, tetrahydroisoquinolinyl, indolyl, benzimidazolyl, benzofuranyl, cinnolinyl, indazolyl, indolizinyl, phthalazinyl, pyridazinyl, triazinyl, isoindolyl, pteridinyl, purinyl, oxadiazolyl, triazolyl, thiadiazolyl, thiadiazolyl, furazanyl, benzofurazanyl, benzothiophenyl, benzothiazolyl, benzoxazolyl, quinazolinyl, quinoxalinyl, naphthyridinyl, tetrahydrofuranyl, and furopyridinyl. Heteroaryl groups are optionally substituted independently with one or more substituents described herein. “Heteroaryloxy” is a heteroaryl group as described bound to the group it substituted via an oxygen, —O—, linker.

“Heterocycloalkyl” is a saturated ring group. It may have, for example, 1, 2, 3, or 4 heteroatoms independently selected from N, S, and O, with remaining ring atoms being carbon. In a typical embodiment, nitrogen is the heteroatm. Monocyclic heterocycloalkyl groups typically have from 3 to about 8 ring atoms or from 4 to 6 ring atoms. Examples of heterocycloalkyl groups include morpholinyl, piperazinyl, piperidinyl, and pyrrolinyl.

The term “mono- and/or di-alkylamino” indicate a secondary or tertiary alkylamino group, wherein the alkyl groups are independently selected alkyl groups, as defined herein. The point of attachment of the alkylamino group is on the nitrogen. Examples of mono- and di-alkylamino groups include ethylamino, dimethylamino, and methyl-propyl-amino.

A “dosage form” means a unit of administration of an active agent. Examples of dosage forms include tablets, capsules, injections, suspensions, liquids, emulsions, implants, particles, spheres, creams, ointments, suppositories, inhalable forms, transdermal forms, buccal, sublingual, topical, gel, mucosal, and the like. A “dosage form” can also include an implant, for example an optical implant.

“Pharmaceutical compositions” are compositions comprising at least one active agent, and at least one other substance, such as a carrier. “Pharmaceutical combinations” are combinations of at least two active agents which may be combined in a single dosage form or provided together in separate dosage forms with instructions that the active agents are to be used together to treat any disorder described herein.

A “pharmaceutically acceptable salt” is a derivative of the disclosed compound in which the parent compound is modified by making inorganic and organic, non-toxic, acid or base addition salts thereof. The salts of the present compounds can be synthesized from a parent compound that contains a basic or acidic moiety by conventional chemical methods. Generally, such salts can be prepared by reacting free acid forms of these compounds with a stoichiometric amount of the appropriate base (such as Na, Ca, Mg, or K hydroxide, carbonate, bicarbonate, or the like), or by reacting free base forms of these compounds with a stoichiometric amount of the appropriate acid. Such reactions are typically carried out in water or in an organic solvent, or in a mixture of the two. Generally, non-aqueous media like ether, ethyl acetate, ethanol, isopropanol, or acetonitrile are typical, where practicable. Salts of the present compounds further include solvates of the compounds and of the compound salts.

Examples of pharmaceutically acceptable salts include, but are not limited to, mineral or organic acid salts of basic residues such as amines; alkali or organic salts of acidic residues such as carboxylic acids; and the like. The pharmaceutically acceptable salts include the conventional non-toxic salts and the quaternary ammonium salts of the parent compound formed, for example, from non-toxic inorganic or organic acids. For example, conventional non-toxic acid salts include those derived from inorganic acids such as hydrochloric, hydrobromic, sulfuric, sulfamic, phosphoric, nitric and the like; and the salts prepared from organic acids such as acetic, propionic, succinic, glycolic, stearic, lactic, malic, tartaric, citric, ascorbic, pamoic, maleic, hydroxymaleic, phenylacetic, glutamic, benzoic, salicylic, mesylic, esylic, besylic, sulfanilic, 2-acetoxybenzoic, fumaric, toluenesulfonic, methanesulfonic, ethane disulfonic, oxalic, isethionic, HOOC—(CH₂)_(n)—COOH where n is 0-4, and the like, or using a different acid that produces the same counterion. Lists of additional suitable salts may be found, e.g., in Remington's Pharmaceutical Sciences, 17th ed., Mack Publishing Company, Easton, Pa., p. 1418 (1985).

The term “carrier” applied to pharmaceutical compositions/combinations of the invention refers to a diluent, excipient, or vehicle with which an active compound is provided.

A “pharmaceutically acceptable excipient” means an excipient that is useful in preparing a pharmaceutical composition/combination that is generally safe, non-toxic and neither biologically nor otherwise inappropriate for administration to a host, typically a human. In one embodiment, an excipient is used that is acceptable for veterinary use.

A “patient” or “host” or “subject” is a human or non-human animal in need of treatment or prevention of any of the disorders as specifically described herein, including but not limited to by modulation of the complement Factor D pathway. Typically the host is a human. A “patient” or “host” or “subject” also refers to for example, a mammal, primate (e.g., human), cows, sheep, goat, horse, dog, cat, rabbit, rat, mice, fish, bird and the like.

A “prodrug” as used herein, means a compound which when administered to a host in vivo is converted into a parent drug. As used herein, the term “parent drug” means any of the presently described chemical compounds described herein. Prodrugs can be used to achieve any desired effect, including to enhance properties of the parent drug or to improve the pharmaceutic or pharmacokinetic properties of the parent. Prodrug strategies exist which provide choices in modulating the conditions for in vivo generation of the parent drug, all of which are deemed included herein. Non-limiting examples of prodrug strategies include covalent attachment of removable groups, or removable portions of groups, for example, but not limited to acylation, phosphorylation, phosphonylation, phosphoramidate derivatives, amidation, reduction, oxidation, esterification, alkylation, other carboxy derivatives, sulfoxy or sulfone derivatives, carbonylation or anhydride, among others.

“Providing a compound with at least one additional active agent,” for example, in one embodiment can mean that the compound and the additional active agent(s) are provided simultaneously in a single dosage form, provided concomitantly in separate dosage forms, or provided in separate dosage forms for administration. In one embodiment, the compound administrations are separated by some amount of time that is within the time in which both the compound and the at least one additional active agent are within the blood stream of a patient. In certain embodiments the compound and the additional active agent need not be prescribed for a patient by the same medical care worker. In certain embodiments the additional active agent or agents need not require a prescription. Administration of the compound or the at least one additional active agent can occur via any appropriate route, for example, oral tablets, oral capsules, oral liquids, inhalation, injection, suppositories, parenteral, sublingual, buccal, intravenous, intraaortal, transdermal, polymeric controlled delivery, non-polymeric controlled delivery, nano or microparticles, liposomes, and/or topical contact.

A “therapeutically effective amount” of a pharmaceutical composition/combination of this invention means an amount effective, when administered to a host, to provide a therapeutic benefit such as an amelioration of symptoms or reduction or dimunition of the disease itself. In one embodiment, a therapeutically effective amount is an amount sufficient to prevent a significant increase or will significantly reduce the detectable level of complement Factor D in the patient's blood, serum, or tissues.

II. Detailed Description of the Active Compounds

PCT Patent Application No. PCT/US2015/017600 and U.S. patent application Ser. No. 14/631,785 titled “Phosphonate Compounds for Treatment of Complement Mediated Disorders” defines a compound of Formula I as:

as well as the pharmaceutically acceptable salts and compositions thereof. In one embodiment, the invention is the use of a compound of Formula I, or a pharmaceutically acceptable salt or composition thereof, wherein R¹² or R¹³ on the A group is phosphonate substituent, including those compounds set out in Table 1, for the treatment of a disorder in a host, typically a human, wherein the disorder is selected from the group disclosed in the Detailed Description, Part IV, Section A.

Formula I can be considered to have a central core, an L substituent, a B substituent (which can be an L-B substituent), and a (C═O)A substituent. Non-limiting examples of compounds falling within Formula I with variations in the variables e.g., A, B, R¹—R^(3′), the central core, and L, are illustrated below. The disclosure includes the use of all combinations of these definitions so long as a stable compound results. In one embodiment, the compound of Formula I is selected from the compounds in Table 1 below.

In certain embodiments, any of the active compounds can be provided in its N-oxide form to a patient in need thereof. In a different embodiment, an N-oxide of one of the active compounds or a precursor of the active compound is used in a manufacturing scheme. In yet another embodiment, the N-oxide is a metabolite of administration of one of the active compounds herein, and may have independent activity. The N-oxide can be formed by treating the compound of interest with an oxidizing agent, for example a suitable peroxide or peracid, to generate an N-oxide compound. For example, a heteroaryl group, for example a pyridyl group, can be treated with an oxidizing agent such as sodium percarbonate in the presence of a rhenium-based catalyst under mild reaction conditions to generate an N-oxide compound. A person skilled in the art will understand that appropriate protecting groups may be necessary to carry out the chemistry. See, Jain, S. L. et al., “Rhenium-Catalyzed Highly Efficient Oxidations of Tertiary Nitrogen Compounds to N-Oxides Using Sodium Percarbonate as Oxygen Source, Synlett, 2261-2663, 2006.

In one embodiment, a sulfur atom in a selected compound as described herein can be oxidized to form a sulfoxide

or a sulfone

For example, the compound 1,3,5-triazo-2,4,6-triphosphorine-2,2,4,4,6,6-tetrachloride (TAPC) is an efficient promoter for the oxidation of sulfides to sulfoxides. See, Bahrami, M. et al., “TAPC-Promoted Oxidation of sulfides and Deoxygenation of Sulfoxides”, J. Org. Chem., 75, 6208-6213 (2010). Oxidation of sulfides with 30% hydrogen peroxide catalyzed by tantalum carbide provides sulfoxides in high yields, see, Kirihara, A., et al., “Tantalum Carbide or Niobium Carbide Catalyzed Oxidation of Sulfides with Hydrogen Peroxide: Highly Efficient and Chemoselective Syntheses of Sulfoxides and Sulfones”, Synlett, 1557-1561 (2010). Sulfides can be oxidized to sulfones using, for example, niobium carbide as the catalyst, see, Kirihara, A., et al., “Tantalum Cardide or Niobium Carbide Catalyzed Oxidation of Sulfides with Hydrogen Peroxide: Highly Efficient and Chemoselective Syntheses of Sulfoxides and Sulfones”, Synlett, 1557-1561 (2010). Urea-hydrogen peroxide adduct is a stable inexpensive and easily handled reagent for the oxidation of sulfides to sulfones, see Varma, R. S. and Naicker, K. P., “The Urea-Hydrogen Peroxide Complex: Solid-State Oxidative Protocols for Hydroxylated Aldehydes and Ketones (Dakin Reaction), Nitriles, Sulfides, and Nitrogen Heterocycles”, Org. Lett., 1, 189-191 (1999). One skilled in the art will appreciate that other heteroatoms, such as nitrogen, may need to be protected and then deprotected while carrying out the oxidation of a sulfur atom to produce the desired compound. Formulas II-XXX

In one aspect, the disclosure includes the use, as further described herein, of a compound or salt of Formula II, III, IV, V, VI, VII, VIII, IX, X, XI, XII, XIII, XIV, XV, XVI, XVII, XVIII, XIX, XX, XXI, XXII, XXIII, XXIV, XXV, XXVI, XXVII, XXVIII, XXIX and XXX. The variables shown in Formula II-XXX carry the definitions set forth in the SUMMARY section for Formula I or any of the definitions set forth in this disclosure.

Additionally, the disclosure includes the use of compounds and salts of Formula I and pharmaceutically acceptable compositions thereof, and any of its subformulae (II-XXX) in which at least one of the following conditions is met in the embodiments described below.

The R¹² and R¹³ Phosphonate Substituents

It has been discovered that a compound of Formula I, a pharmaceutically acceptable salt or composition thereof, wherein at least one of R¹² or R¹³ on the A group is a phosphonate, is a superior inhibitor of complement factor D.

One of R¹² and R¹³ is selected from R³¹ and the other of R¹² and R¹³ is selected from R³². In another embodiment, each of R¹² and R¹³ can be independently selected from R³².

R³¹ is selected from hydrogen, halogen, hydroxyl, nitro, cyano, amino, —COOH, C₁-C₂haloalkyl, C₁-C₂haloalkoxy, C₁-C₆alkyl, —C₀-C₄alkyl(C₃-C₇cycloalkyl), C₂-C₆alkenyl, C₂-C₆alkanoyl, C₁-C₆alkoxy, C₂-C₆alkenyloxy, —C(O)OR⁹, C₁-C₆thioalkyl, —C₀-C₄alkylNR⁹R¹⁰, —C(O)NR⁹R¹⁰, —SO₂R⁹, —SO₂NR⁹R¹⁰, —OC(O)R⁹, and —C(NR⁹)NR⁹R¹⁰, each of which R³¹ other than hydrogen, halogen, hydroxyl, nitro, cyano, C₁-C₂haloalkyl, and C₁-C₂haloalkoxy is unsubstituted or substituted with one or more substituents independently selected from halogen, hydroxyl, nitro, cyano, amino, —COOH, —CONH₂C₁-C₂haloalkyl, and C₁-C₂haloalkoxy, and each of which R³¹ is also optionally substituted with one substituent selected from phenyl and 4- to 7-membered heterocycle containing 1, 2, or 3 heteroatoms independently selected from N, O, and S; which phenyl or 4- to 7-membered heterocycle is unsubstituted or substituted with one or more substituents independently selected from halogen, hydroxyl, nitro, cyano, C₁-C₆alkyl, C₂-C₆alkenyl, C₂-C₆alkanoyl, C₁-C₆alkoxy, (mono- and di-C₁-C₆alkylamino)C₀-C₄alkyl, C₁-C₆alkylester, —C₀-C₄alkyl)(C₃-C₇cycloalkyl), C₁-C₂haloalkyl, and C₁-C₂haloalkoxy;

R³² is —P(O)R²⁰R²⁰.

R²⁰ is independently selected at each occurrence from hydroxyl, C₁-C₆alkoxy, C₁-C₆haloalkoxy, C₁-C₆alkyl, (C₃-C₇cycloalkyl)C₀-C₄alkyl-, (aryl)C₀-C₄alkyl-, —O—C₀-C₄alkyl(aryl), —O—C₀-C₄alkyl(C₃-C₇cycloalkyl), (4- to 7-membered heterocycloalkyl)C₀-C₄alkyl-O— having 1, 2, or 3 heteroatoms independently selected from N, O, and S; (5- or 6-membered unsaturated or aromatic heterocycle)C₀-C₄alkyl-O— having 1, 2, or 3 heteroatoms independently selected from N, O, and S; —O(CH₂)₂₋₄O(CH₂)₈₋₁₈, —OC(R^(20a))₂OC(O)OR^(20b), —OC(R^(20a))₂OC(O)R^(20b), an N-linked amino acid or an N-linked amino acid ester and each R²⁰ can be optionally substituted;

R^(20a) is independently selected at each occurrence from hydrogen, C₁-C₈alkyl, C₂-C₈alkenyl, C₂-C₈alkynyl, (aryl)C₀-C₄alkyl-, (aryl)C₂-C₈alkenyl- or (aryl)C₂-C₈alkynyl-; or

two R^(20a) groups can be taken together with the carbon that they are bonded to form a 3-6 membered heterocycloalkyl having 1, 2, or 3 heteroatoms independently selected from N, O, and S, or a 3-6 membered carbocyclic ring.

R^(20b) is independently selected at each occurrence from C₁-C₈alkyl, C₂-C₈alkenyl, C₂-C₈alkynyl, (aryl)C₀-C₄alkyl, (aryl)C₂-C₈alkenyl or (aryl)C₂-C₈alkynyl.

When A is indole or indazole and X¹² is N, X¹³ is CR¹³, wherein R¹³ is R³².

When A is an indole or indazole and X¹³ is N, X¹² is CR¹², wherein R¹² is R³².

In certain embodiments, R³² is selected from the structures of FIG. 6.

In one embodiment, two R²⁰ groups in a P(O)R²⁰R²⁰ phosphonate can come together to form a heterocyclic ring that can be optionally substituted with an R¹⁰⁰ group, wherein R¹⁰⁰ is aryl, heteroaryl, hetercycle, alkyl, alkenyl, alkynyl and cycloalkyl. See for example: HepDirect (Cyclic 1-aryl-1,3-propanyl esters) Prodrugs: Activation via CYP-mediated oxidation of the benzylic carbon. See Hecker, S. J. et al. J. Med. Chem. 2007, 50, 3891-3896.

Non-Limiting R¹²/R¹³ Embodiments

In one embodiment, R¹² is —P(O)R²⁰R²⁰.

In one embodiment, R¹³ is —P(O)R²⁰R²⁰.

In one embodiment, the disclosure provides compounds of Formula I, wherein;

one of R¹² and R¹³ is H and the other of R¹² and R¹³ is R³², where

R³² is —P(O)R²⁰R²⁰;

wherein R²⁰ is as defined in the summary section above.

In another embodiment, the disclosure provides compounds of Formula I, wherein;

R¹, R^(1′), R², and R^(3′) are all hydrogen;

R² is fluoro and R³ is hydrogen, —C₀-C₄alkyl(C₃-C₇cycloalkyl), or —O—C₀-C₄alkyl(C₃-C₇cycloalkyl);

R⁵ is hydrogen, halogen, or C₁-C₂alkyl;

R¹¹, R¹³, R¹⁴, and R¹⁵ if present, are independently selected at each occurrence from hydrogen, halogen, hydroxyl, amino, C₁-C₄alkyl, C₁-C₄alkoxy, —C₀-C₂alkyl(mono- and di-C₁-C₂alkylamino), trifluoromethyl, and trifluoromethoxy;

X¹² is CR¹²; and

R¹² is —P(O)R²⁰R²⁰;

wherein R²⁰ is as defined in the summary section above.

In one embodiment, the disclosure provides compounds of Formula I, wherein;

m is 0 or 1;

R² is halogen, R^(2′) is hydrogen or halogen, and R³ is hydrogen, halogen, —C₀-C₄alkyl(C₃-C₇cycloalkyl), or —O—C₀-C₄alkyl(C₃-C₇cycloalkyl);

R⁶ is —C(O)C₁-C₄alkyl, —C(O)NH₂, —C(O)CF₃, —C(O)(C₃-C₇cycloalkyl), or -ethyl(cyanoimino);

one of R¹² and R¹³ is selected from hydrogen, halogen, C₁-C₄alkyl, C₁-C₄alkoxy, trifluoromethyl, and trifluoromethoxy; the other of R¹² and R¹³ is R³², where

R³² is —P(O)R²⁰R²⁰;

wherein R²⁰ is as defined in the summary section above.

In one embodiment, the disclosure provides compounds of Formula I, wherein;

one of R¹² and R¹³ is hydrogen, hydroxyl, halogen, methyl, or methoxy; and the other of R¹² and R¹³ is R³², where

R³² is —P(O)R²⁰R²⁰;

wherein R²⁰ is as defined in the summary section above.

In one embodiment, R³² may be unsubstituted or substituted with one or more substituents independently selected from halogen, hydroxyl, nitro, cyano, amino, oxo, —B(OH)₂, —Si(CH₃)₃, —COOH, —CONH₂, —P(O)(OH)₂, C₁-C₆alkyl, C₁-C₆alkoxy, —C₀-C₂alkyl(mono- and di-C₁-C₄alkylamino), C₁-C₆alkylester, C₁-C₄alkylamino, C₁-C₄hydroxylalkyl, C₁-C₂haloalkyl, and C₁-C₂haloalkoxy.

Central Core Moiety

The central core moiety in Formula T is illustrated below:

wherein:

Q¹ is N(R¹) or C(R¹R^(1′));

Q² is C(R²R^(2′)), C(R²R^(2′))—C(R²R^(2′)), S, O, N(R²) or C(R²R^(2′))O;

Q³ is N(R³), S, or C(R³R^(3′));

X¹ and X² are independently N, CH, or CZ, or X¹ and X² together are C═C; and

wherein Q¹, Q², Q³, X¹, and X² are selected such that a stable compound results.

Non-limiting examples of the

ring are illustrated in FIG. 5 (any of which can be otherwise substituted with R¹, R^(1′), R², R^(2′), R³, and R^(3′)).

In an alternate embodiment, the

ring is replaced by one of the following core structures:

wherein q is 0, 1, 2 or 3 and r is 1, 2 or 3.

Any of the structures illustrated herein, e.g., A, B, L or central core can be optionally substituted with 0, 1, 2, 3, or 4, as appropriate, and independently, selected from R⁷⁵, wherein R⁷⁵ is selected from hydrogen, halogen, hydroxyl, nitro, cyano, amino, C₁-C₆alkyl, C₁-C₆haloalkyl, C₂-C₆alkenyl, C₂-C₆alkynyl, C₁-C₆thioalkyl, C₁-C₆alkoxy, -JC₃-C₇cycloalkyl, —B(OH)₂, -JC(O)NR⁹R²³, -JOSO₂OR²¹, —C(O)(CH₂)₁₋₄S(O)R²¹, —O(CH₂)₁₋₄S(O)NR²¹R²², -JOP(O)(OR²¹)(OR²²), -JP(O)(OR²¹)(OR²²), -JOP(O)(OR²¹)R²², -JP(O)(OR²¹)R²², -JOP(O)R²¹R²², -JP(O)R²¹R²², -JSP(O)(OR²¹)(OR²²), -JSP(O)(OR²¹)(R²²), -JSP(O)(R²¹)(R²²), -JNR⁹P(O)(NHR²¹)(NHR²²), -JNR⁹P(O)(OR²¹)(NHR²²), -JNR⁹P(O)(OR²¹)(OR²²), -JC(S)R²¹, -JNR²¹SO₂R²², -JNR⁹S(O)NR¹⁰R²², -JNR⁹SO₂NR¹⁰R²², -JSO₂NR⁹COR²², -JSO₂NR⁹CONR²¹R²², - JNR²¹SO₂R²², -JC(O)NR²¹SO₂R²², -JC(NH₂)═NR²², -JCH(NH₂)NR⁹S(O)₂R²², -JOC(O)NR²¹R²², -JNR²¹C(O)OR²², -JNR²¹OC(O)R²², —(CH₂)₁₋₄C(O)NR²¹R²², -JC(O)NR²⁴R²⁵, -JNR⁹C(O)R²¹, -JC(O)R²¹, -JNR⁹C(O)NR¹⁰R²², —CCR²¹, —(CH₂)₁₋₄OC(O)R²¹, -JC(O)OR²³; each of which R⁷⁵ may be unsubstituted or substituted with one or more substituents independently selected from halogen, hydroxyl, nitro, cyano, amino, oxo, —B(OH)₂, —Si(CH₃)₃, —COOH, —CONH₂, —P(O)(OH)₂, C₁-C₆alkyl, —C₀-C₄alkyl(C₃-C₇cycloalkyl), C₁-C₆alkoxy, —C₀-C₄alkyl(mono- and di-C₁-C₄alkylNR⁹R¹⁰), C₁-C₆alkylester, C₁-C₄alkylamino, C₁-C₄hydroxylalkyl, C₁-C₂haloalkyl, C₁-C₂haloalkoxy, —OC(O)R⁹, —NR⁹C(O)R¹⁰, —C(O)NR⁹R¹⁰, —OC(O)NR⁹R¹⁰, —NR⁹C(O)OR¹⁰, C₁-C₂haloalkyl, and C₁-C₂haloalkoxy, S(O)═NHR²¹, SF₅, and JC(R⁹)═NR²¹ and SO₂OR²¹.

R and R′ are independently selected from H, alkyl, cycloalkyl, cycloalkylalkyl, heterocycle, heterocycloalkyl, aryl, aralkyl, heteroaryl, heteroarylalkyl wherein each group can be optionally substituted or any other substituent group herein that provides the desired properties. In some embodiments, the ring includes one or more chiral carbon atoms. The invention includes embodiments in which the chiral carbon can be provided as an enantiomer, or mixtures of enantiomers, including a racemic mixture. Where the ring includes more than one stereocenter, all of the enantiomers and diastereomers are included in the invention as individual species.

Z is F, Cl, NH₂, CH₃, CH₂D, CHD₂, or CD₃.

R¹, R^(1′), R², R^(2′), R³, and R^(3′) are independently selected at each occurrence, as appropriate, and only where a stable compound results, from hydrogen, halogen, hydroxyl, nitro, cyano, amino, C₁-C₆alkyl, C₂-C₆alkenyl, C₂-C₆alkynyl, C₁-C₆alkoxy, C₂-C₆alkynyl, C₂-C₆alkanoyl, C₁-C₆thioalkyl, hydroxyC₁-C₆alkyl, aminoC₁-C₆alkyl, —C₀-C₄alkylNR⁹R¹⁰, —C(O)OR⁹, —OC(O)R⁹, —NR⁹C(O)R¹⁰, —C(O)NR⁹R¹⁰, —OC(O)NR⁹R¹⁰, —NR⁹C(O)OR¹⁰, C₁-C₂haloalkyl, and C₁-C₂haloalkoxy, where R⁹ and R¹⁰ are independently selected at each occurrence from hydrogen, C₁-C₆alkyl, (C₃-C₇cycloalkyl)C₀-C₄alkyl, —C₀-C₄alkyl(C₃-C₇cycloalkyl), and —O—C₀-C₄alkyl(C₃-C₇cycloalkyl).

Examples of central cores include, but are not limited to:

R¹⁰¹ is C₁-C₄ alkyl or C₃-C₇ cycloalkyl.

R¹⁰² is C₁-C₄ alkyl, fluorine, chlorine, or bromine.

Non-Limiting Central Core Embodiments

In alternative embodiments, R¹ and R^(1′) or R³ and R^(3′) may be taken together to form a 3- to 6-membered carbocyclic spiro ring or a 3- to 6-membered heterocyclic spiro ring containing 1 or 2 heteroatoms independently selected from N, O, or S; R² and R^(2′) may be taken together to form a 3- to 6-membered carbocyclic spiro ring; or R² and R^(2′) may be taken together to form a 3- to 6-membered heterocyclic spiro ring;

each of which ring may be unsubstituted or substituted with 1 or more substituents independently selected from halogen (and in particular F), hydroxyl, cyano, —COOH, C₁-C₄alkyl (including in particular methyl), C₂-C₄alkenyl, C₂-C₄alkynyl, C₁-C₄alkoxy, C₂-C₄alkanoyl, hydroxyC₁-C₄alkyl, (mono- and di-C₁-C₄alkylamino)C₀-C₄alkyl, —C₀-C₄alkyl(C₃-C₇cycloalkyl), —O—C₀-C₄alkyl(C₃-C₇cycloalkyl), C₁-C₂haloalkyl, and C₁-C₂haloalkoxy.

In alternative embodiments, R¹ and R² may be taken together to form a 3-membered carbocyclic ring; R¹ and R² may be taken together to form a 4- to 6-membered carbocyclic or aryl ring or a 4- to 6-membered heterocyclic or heteroaryl ring containing 1 or 2 heteroatoms independently selected from N, O, and S; or R² and R³, if bound to adjacent carbon atoms, may be taken together to form a 3- to 6-membered carbocyclic or aryl ring or a 3- to 6-membered heterocyclic or heteroaryl ring; each of which ring may be unsubstituted or substituted with 1 or more substituents independently selected from halogen (and in particular F), hydroxyl, cyano, —COOH, C₁-C₄alkyl (including in particular methyl), C₂-C₄alkenyl, C₂-C₄alkynyl, C₁-C₄alkoxy, C₂-C₄alkanoyl, hydroxyC₁-C₄alkyl, (mono- and di-C₁-C₄alkylamino)C₀-C₄alkyl, —C₀-C₄alkyl(C₃-C₇cycloalkyl), —O—C₀-C₄alkyl(C₃-C₇cycloalkyl), C₁-C₂haloalkyl, and C₁-C₂haloalkoxy.

In one embodiment, the central core moiety is proline.

In one embodiment, the central core moiety is 4-fluoroproline.

In one embodiment, R¹, R^(1′), R^(2′), R³, and R^(3′), if present, are all hydrogen; and R² is fluoro.

In one embodiment, R¹, R^(1′), R^(2′), and R^(3′), if present, are all hydrogen; and R² is fluoro and R³ is —C₀-C₄alkyl(C₃-C₇cycloalkyl) or —O—C₀-C₄alkyl(C₃-C₇cycloalkyl).

In one embodiment, R¹ and R² are taken together to form a 3- to 6-membered cycloalkyl group, and R¹, R^(2′), R³, and R^(3′), where present, are all hydrogen.

In one embodiment, R¹, R^(1′), R³, and R^(3′), if present, are all hydrogen, and R² and R^(2′) are taken together to form a 5- or 6-membered heterocycloalkyl group having 1 or 2 oxygen atoms.

In one embodiment, R¹ is hydrogen and R² is fluoro.

In one embodiment, R¹ and R² are joined to form a 3 membered ring.

The disclosure includes compounds of Formula I in which the central pyrrolidine is vinyl substituted, for example:

In one embodiment, the compound of Formula I has the structure:

In one embodiment, the central pyrrolidine is modified by addition of a second heteroatom to a pyrrolidine ring, such as N, O, S, or Si, for example:

Another modification within the scope of the disclosure is joining a substituent on the central pyrrolidine ring to R⁷ or R⁸ to form a 5- to 6-membered heterocyclic ring, for example:

Example compounds having the modifications disclosed above include:

Central Core L-B Substituents

The central core L substituents and B substituents in Formula I are illustrated

L is a bond or is selected from the formulas:

where R¹⁷ is hydrogen, C₁-C₆alkyl, or —C₀-C₄alkyl(C₃-C₇cycloalkyl) and R¹⁸ and R^(18′) are independently selected from hydrogen, halogen, hydroxymethyl, and methyl; and m is 0, 1, 2, or 3.

B is a monocyclic or bicyclic carbocyclic; a monocyclic or bicyclic carbocyclic-oxy group; a monocyclic, bicyclic, or tricyclic heterocyclic group having 1, 2, 3, or 4 heteroatoms independently selected from N, O, and S and from 4 to 7 ring atoms per ring; C₂-C₆alkenyl; C₂-C₆alkynyl; —(C₀-C₄alkyl)(aryl); —(C₀-C₄alkyl)(heteroaryl); or —(C₀-C₄alkyl)(biphenyl).

Each of which B is unsubstituted or substituted with one or more substituents independently selected from R³³ and R³⁴, and 0 or 1 substituents selected from R³⁵ and R³⁶:

R³³ is independently selected from halogen, hydroxyl, —COOH, cyano, C₁-C₆alkyl, C₂-C₆alkanoyl, C₁-C₆alkoxy, —C₀-C₄alkylNR⁹R¹⁰, —SO₂R⁹, C₁-C₂haloalkyl, and C₁-C₂haloalkoxy;

R³⁴ is independently selected from nitro, C₂-C₆alkenyl, C₂-C₆alkynyl, C₁-C₆thioalkyl, -JC₃-C₇cycloalkyl, —B(OH)₂, -JC(O)NR⁹R²³, -JOSO₂OR²¹, —C(O)(CH₂)₁₋₄S(O)R²¹, —O(CH₂)₁₋₄S(O)NR²¹R²², -JOP(O)(OR²¹)(OR²²), -JP(O)(OR²¹)(OR²²), -JOP(O)(OR²¹)R²², -JP(O)(OR²¹)R²², -JOP(O)R²¹R²², -JP(O)R²¹R²², -JSP(O)(OR²¹)(OR²²), -JSP(O)(OR²¹)(R²²), -JSP(O)(R²¹)(R²²), -JNR⁹P(O)(NHR²¹)(NHR²²), -JNR⁹P(O)(OR²¹)(NHR²²), -JNR⁹P(O)(OR²¹)(OR²²), -JC(S)R²¹, -JNR²¹SO₂R²², -JNR⁹S(O)NR¹⁰R²², -JNR⁹SO₂NR¹⁰R²², -JSO₂NR⁹COR²², -JSO₂NR⁹CONR²¹R²², -JNR²¹SO₂R²², -JC(O)NR²¹SO₂R²², -JC(NH₂)NR²², -JC(NH₂)NR⁹S(O)₂R²², -JOC(O)NR²¹R²¹R²², -JNR²¹C(O)OR²², -JNR²¹OC(O)R²², —(CH₂)₁₋₄C(O)NR²¹R²², -JC(O)N²⁴R²⁴R²⁵, -JNR⁹C(O)R²¹, -JC(O)R²¹, -JNR⁹C(O)NR¹⁰R²², —CCR²¹, —(CH₂)₁₋₄OC(O)R²¹, and -JC(O)OR²³; each of which R³⁴ may be unsubstituted or substituted with one or more substituents independently selected from halogen, hydroxyl, nitro, cyano, amino, oxo, —B(OH)₂, —Si(CH₃)₃, —COOH, —CONH₂, —P(O)(OH)₂, C₁-C₆alkyl, —C₀-C₄alkyl(C₃-C₇cycloalkyl), C₁-C₆alkoxy, —C₀-C₂alkyl(mono- and di-C₁-C₄alkylamino), C₁-C₆alkylester, C₁-C₄alkylamino, C₁-C₄hydroxylalkyl, C₁-C₂haloalkyl, and C₁-C₂haloalkoxy;

R³⁵ is independently selected from naphthyl, naphthyloxy, indanyl, (4- to 7-membered heterocycloalkyl)C₀-C₄alkyl containing 1 or 2 heteroatoms selected from N, O, and S, and bicyclic heterocycle containing 1, 2, or 3 heteroatoms independently selected from N, O, and S, and containing 4- to 7-ring atoms in each ring; each of which R³⁵ is unsubstituted or substituted with one or more substituents independently selected from halogen, hydroxyl, nitro, cyano, C₁-C₆alkyl, C₂-C₆alkenyl, C₂-C₆alkanoyl, C₁-C₆alkoxy, (mono- and di-C₁-C₆alkylamino)C₀-C₄alkyl, C₁-C₆alkylester, —C₀-C₄alkyl(C₃-C₇cycloalkyl), —SO₂R⁹, C₁-C₂haloalkyl, and C₁-C₂haloalkoxy; and

R³⁶ is independently selected from tetrazolyl, (phenyl)C₀-C₂alkyl, (phenyl)C₁-C₂alkoxy, phenoxy, and 5- or 6-membered heteroaryl containing 1, 2, or 3 heteroatoms independently selected from N, O, B, and S, each of which R³⁶ is unsubstituted or substituted with one or more substituents independently selected from halogen, hydroxyl, nitro, cyano, C₁-C₆alkyl, C₂-C₆alkenyl, C₂-C₆alkanoyl, C₁-C₆alkoxy, (mono- and di-C₁-C₆alkylamino)C₀-C₄alkyl, C₁-C₆alkylester, —C₀-C₄alkyl(C₃-C₇cycloalkyl), —SO₂R⁹, —OSi(CH₃)₂C(CH₃)₃, —Si(CH₃)₂C(CH₃)₃, C₁-C₂haloalkyl, and C₁-C₂haloalkoxy.

J is independently selected at each occurrence from a covalent bond, C₁-C₄alkylene, —OC₁-C₄alkylene, C₂-C₄alkenylene, and C₂-C₄alkynylene.

Examples of B moieties include, but are not limited to

Non-Limiting L-B Embodiments

In one embodiment, -L-B— is

where R²⁶ and R²⁷ are independently selected from hydrogen, halogen, hydroxyl, nitro, cyano, C₁-C₆alkyl, C₂-C₆alkenyl, C₂-C₆alkanoyl, C₁-C₆alkoxy, C₁-C₆thioalkyl, —C₀-C₄alkyl(mono- and di-C₁-C₆alkylamino), —C₀-C₄alkyl(C₃-C₇cycloalkyl), —C₀-C₄alkoxy(C₃-C₇cycloalkyl), C₁-C₂haloalkyl, C₁-C₂haloalkoxy, and C₁-C₂haloalkylthio.

In another embodiment, -L-B— is

wherein

R¹⁸ and R^(18′) are independently selected from hydrogen, halogen, hydroxymethyl, and methyl; and m is 0 or 1; and

R²⁶, R²⁷, and R²⁸ are independently selected from hydrogen, halogen, hydroxyl, nitro, cyano, C₁-C₆alkyl, C₂-C₆alkenyl, C₂-C₆alkanoyl, C₁-C₆alkoxy, C₁-C₆thioalkyl, (mono- and di-C₁-C₆alkylamino)C₀-C₄alkyl, (C₃-C₇cycloalkyl)C₀-C₄alkyl, (aryl)C₀-C₄alkyl-, (heteroaryl)C₀-C₄alkyl-, and —C₀-C₄alkoxy(C₃-C₇cycloalkyl); each of which R²⁶, R²⁷, and R²⁸ other than hydrogen, halogen, hydroxyl, nitro, cyano, is unsubstituted or substituted with one or more substituents independently selected from halogen, hydroxyl, amino, C₁-C₂alkoxy, C₁-C₂haloalkyl, (C₃-C₇cycloalkyl)C₀-C₄alkyl-, and C₁-C₂haloalkoxy; and

R²⁹ is hydrogen, C₁-C₂alkyl, C₁C₂haloalkyl or —Si(CH₃)₂C(CH₃)₃.

In one embodiment, m is 0.

In one embodiment, the disclosure further includes the use of compounds and salts of Formula I in which B is 2-fluoro-3-chlorophenyl. In another embodiment, another carbocyclic, aryl, heterocyclic, or heteroaryl group such as 2-bromo-pyridin-6-yl, 1-(2,2,2-trifluoroethyl)-1H-pyrazol-3-yl, 2,2-dichlorocyclopropylmethyl, or 2-fluoro-3-trimethylsilylphenyl is used.

In another embodiment, B is phenyl, pyridyl, or indanyl each of which is unsubstituted or substituted with one or more substituents independently selected from hydrogen, halogen, hydroxyl, nitro, cyano, C₁-C₆alkyl, C₂-C₆alkenyl, C₂-C₆alkanoyl, C₁-C₆alkoxy, C₁-C₆thioalkyl, (mono- and di-C₁-C₆alkylamino)C₀-C₄alkyl, (C₃-C₇cycloalkyl)C₀-C₄alkyl, —C₀-C₄alkoxy(C₃-C₇cycloalkyl), (phenyl)C₀-C₂alkyl, (pyridyl)C₀-C₂alkyl; each of which substituents other than hydrogen, halogen, hydroxyl, nitro, cyano, is unsubstituted or substituted with one or more substituents independently selected from halogen, hydroxyl, amino, C₁-C₂alkyl, C₁-C₂alkoxy, —OSi(CH₃)₂C(CH₃)₃, —Si(CH₃)₂C(CH₃)₃, C₁-C₂haloalkyl, and C₁-C₂haloalkoxy.

In another embodiment, B is phenyl or pyridyl substituted with 1, 2, or 3 substituents selected from chloro, bromo, hydroxyl, —SCF₃, C₁-C₂alkyl, C₁-C₂alkoxy, trifluoromethyl, phenyl and trifluoromethoxy each of which substituents other than chloro, bromo, hydroxyl, —SCF₃, can be optionally substituted.

In certain embodiments, B is a 2-fluoro-3-chlorophenyl or a 2-fluoro-3-trifluoromethoxyphenyl group.

In one embodiment, B is pyridyl, optionally substituted with halogen, C₁-C₂alkoxy, and trifluoromethyl.

In one embodiment, B is phenyl, substituted with 1, 2, or 3 substituents independently selected from halogen, C₁-C₂alkyl, C₁-C₂alkoxy, trifluoromethyl, and optionally substituted phenyl.

In one embodiment, R²³ is independently selected at each occurrence from (C₃-C₇cycloalkyl)C₀-C₄alkyl, (phenyl)C₀-C₄alkyl, (4- to 7-membered heterocycloalkyl)C₀-C₄alkyl having 1, 2, or 3 heteroatoms independently selected from N, O, and S, and (5- or 6-membered unsaturated or aromatic heterocycle)C₀-C₄alkyl having 1, 2, or 3 heteroatoms independently selected from N, O, and S.

In one embodiment, B is selected from FIG. 7, wherein R²⁷ is hydrogen, methyl, or trifluoromethyl; R²⁸ is hydrogen or halogen; and R²⁹ is hydrogen, methyl, trifluoromethyl, or —Si(CH₃)₂C(CH₃)₃.

In an alternative embodiment, B is selected from FIG. 8.

Central Core (C═O)A Substituent

The central core (C═O)A substituent in Formula I is illustrated below:

A is a group selected from:

R⁴ is selected from —CHO, —CONH₂, C₂-C₆alkanoyl, hydrogen, —SO₂NH₂, —C(CH₂)₂F, —CH(CF₃)NH₂, C₁-C₆alkyl, —C₀-C₄alkyl(C₃-C₇cycloalkyl), —C(O)C₀-C₂alkyl(C₃-C₇cycloalkyl),

each of which R⁴ other than hydrogen, —CHO, and —CONH₂, is unsubstituted or substituted with one or more of amino, imino, halogen, hydroxyl, cyano, cyanoimino, C₁-C₂alkyl, C₁-C₂alkoxy, —C₀-C₂alkyl(mono- and di-C₁-C₄alkylamino), C₁-C₂haloalkyl, and C₁-C₂haloalkoxy.

R⁵ and R⁶ are independently selected from —CHO, —C(O)NH₂, —C(O)NH(CH₃), C₂-C₆alkanoyl, hydrogen, hydroxyl, halogen, cyano, nitro, —COOH, —SO₂NH₂, vinyl, C₁-C₆alkyl (including methyl), C₂-C₆alkenyl, C₁-C₆alkoxy, —C₀-C₄alkyl(C₃-C₇cycloalkyl), —C(O)C₀-C₄alkyl(C₃-C₇cycloalkyl), —P(O)(OR⁹)₂, —OC(O)R⁹, —C(O)OR⁹, —C(O)N(CH₂CH₂R⁹)(R¹⁰), —NR⁹C(O)R¹⁰, phenyl, or 5- to 6-membered heteroaryl.

Each R⁵ and R⁶ other than hydrogen, hydroxyl, cyano, and —COOH is unsubstituted or optionally substituted. For example, R⁵ and R⁶ other than hydrogen, hydroxyl, cyano, and —COOH may be substituted with one or more substituents independently selected from halogen, hydroxyl, amino, imino, cyano, cyanoimino, C₁-C₂alkyl, C₁-C₄alkoxy, —C₀-C₂alkyl(mono- and di-C₁-C₄alkylamino), C₁-C₂haloalkyl, and C₁-C₂haloalkoxy.

R^(6′) is hydrogen, halogen, hydroxyl, C₁-C₄alkyl, —C₀-C₄alkyl(C₃-C₇cycloalkyl), or C₁-C₄alkoxy; or R⁶ and R^(6′) may be taken together to form an oxo, vinyl, or imino group.

R⁷ is hydrogen, C₁-C₆alkyl, or —C₀-C₄alkyl(C₃-C₇cycloalkyl).

R⁸ and R^(8′) are independently selected from hydrogen, halogen, hydroxyl, C₁-C₆alkyl, —C₀-C₄alkyl(C₃-C₇cycloalkyl), C₁-C₆alkoxy, and (C₁-C₄alkylamino)C₀-C₂alkyl; or R⁸ and R^(8′) are taken together to form an oxo group; or R⁸ and R^(8′) can be taken together with the carbon that they are bonded to form a 3-membered carbocyclic ring.

R¹⁶ is absent or may include one or more substituents independently selected from halogen, hydroxyl, nitro, cyano, C₁-C₆alkyl, C₂-C₆alkenyl, C₂-C₆alkanoyl, C₁-C₆alkoxy, —C₀-C₄alkyl(mono- and di-C₁-C₆alkylamino), —C₀-C₄alkyl(C₃-C₇cycloalkyl), C₁-C₂haloalkyl, and C₁-C₂haloalkoxy.

R¹⁹ is hydrogen, C₁-C₆alkyl, C₂-C₆alkenyl, C₂-C₆alkanoyl, —SO₂C₁-C₆alkyl, (mono- and di-C₁-C₆alkylamino)C₁-C₄alkyl, —C₀-C₄alkyl(C₃-C₇cycloalkyl), —C₀-C₄alkyl(C₃-C₇heterocycloalkyl), —C₀-C₄alkyl(aryl), C₀-C₄alkyl(heteroaryl), and wherein R¹⁹ other than hydrogen is unsubstituted or substituted with one or more substituents independently selected from halogen, hydroxyl, amino, —COOH, and —C(O)OC₁-C₄alkyl.

X¹¹ is N or CR¹¹.

X¹² is N or CR¹².

X¹³ is N or CR¹³.

X¹⁴ is N or CR¹⁴.

No more than 2 of X¹¹, X¹², X¹³, and X¹⁴ are N.

R¹¹, R¹⁴, and R¹⁵ are independently selected at each occurrence from hydrogen, halogen, hydroxyl, nitro, cyano, —O(PO)(OR⁹)₂, —(PO)(OR⁹)₂, C₁-C₆alkyl, C₂-C₆alkenyl, C₂-C₆alkynyl, C₂-C₆alkenyl(aryl), C₂-C₆alkenyl(cycloalkyl), C₂-C₆alkenyl(heterocycle), C₂-C₆alkenyl(heteroaryl), C₂-C₆alkynyl, C₂-C₆alkynyl(aryl), C₂-C₆alkynyl(cycloalkyl), C₂-C₆alkynyl(heterocycle), C₂-C₆alkynyl(heteroaryl), C₂-C₆alkanoyl, C₁-C₆alkoxy, C₁-C₆thioalkyl, —C₀-C₄alkyl(mono- and di-C₁-C₆alkylamino), —C₀-C₄alkyl(C₃-C₇cycloalkyl), —C₀-C₄alkoxy(C₃-C₇cycloalkyl), C₁-C₂haloalkyl, and C₁-C₂haloalkoxy.

In one embodiment, R⁵ and R⁶ are independently selected from —CHO, —C(O)NH₂, —C(O)NH(CH₃), C₂-C₆alkanoyl, and hydrogen.

In one embodiment, each R⁵ and R⁶ other than hydrogen, hydroxyl, cyano, and —COOH is unsubstituted or substituted with one or more substituents independently selected from halogen, hydroxyl, amino, imino, cyano, cyanoimino, C₁-C₂alkyl, C₁-C₄alkoxy, —C₀-C₂alkyl(mono- and di-C₁-C₄alkylamino), C₁-C₂haloalkyl, and C₁-C₂haloalkoxy.

In one embodiment, R⁸ and R^(8′) are independently hydrogen or methyl.

In one embodiment, R⁸ and R^(8′) are hydrogen.

In one embodiment, R⁷ is hydrogen or methyl.

In one embodiment, R⁷ is hydrogen.

Embodiments of Formulas IA, IB, IC, and ID

To further illustrate the invention, various embodiments of Formula IA, IB, IC and ID are provided. These are presented by way of example to show some of the variations among presented compounds within the invention and can be applied to any of the Formulas I-XXX.

In one aspect, this disclosure includes compounds and salts of Formula IA:

where R⁶, R¹³, and B may carry any of the definitions set forth herein for this variable.

In another aspect, this disclosure includes compounds and salts of Formula IB, IC, and ID.

In Formulas IA, IB, IC, and ID, the variables may include any of the definitions set forth herein that results in a stable compound. In certain embodiments, the following conditions apply for Formula IB and IC.

In some embodiments, uses of structures are provided including Formulas IB and IC, wherein m=0, R¹ is H, R² is F, R⁶ is alkanoyl, R¹² is R³², R³² is —P(O)R²⁰R²⁰, R¹³ is H, and B is heteroaryl.

In some embodiments, uses of structures are provided including Formulas IB and IC, wherein m=0, R¹ and R² are joined to form a 3 membered ring, R⁶ is alkanoyl, R¹² is R³², R³² is —P(O)R²⁰R²⁰, R¹³ is H, and B is heteroaryl.

In some embodiments, uses of structures are provided including Formulas IB and IC, wherein m=0, R¹ is H, R² is F, R⁶ is amide, R¹² is R³², R³² is —P(O)R²⁰R²⁰, R¹³ is H, and B is heteroaryl.

In some embodiments, uses of structures are provided including Formulas IB and IC, wherein m=0, R¹ and R² are joined to form a 3 membered ring, R⁶ is amide, R¹² is R³², R³² is —P(O)R²⁰R²⁰, R¹³ is H, and B is heteroaryl.

In some embodiments, uses of structures are provided including Formulas IB and IC, wherein m=0, R¹ is H, R² is F, R⁶ is alkanoyl, R¹² is H, R¹³ is R³², R³² is —P(O)R²⁰R²⁰, and B is heteroaryl.

In some embodiments, uses of structures are provided including Formulas IB and IC, wherein m=0, R¹ and R² are joined to form a 3 membered ring, R⁶ is alkanoyl, R¹² is H, R¹³ is R³², R³² is —P(O)R²⁰R²⁰, and B is heteroaryl.

In some embodiments, uses of structures are provided including Formulas IB and IC, wherein m=0, R¹ is H, R² is F, R⁶ is amide, R¹² is H, R¹³ is R³², R³² is —P(O)R²⁰R²⁰, and B is heteroaryl.

In some embodiments, uses of structures are provided including Formulas IB and IC, wherein m=0, R¹ and R² are joined to form a 3 membered ring, R⁶ is amide, R¹² is H, R¹³ is R³², R³² is —P(O)R²⁰R²⁰, and B is heteroaryl.

In some embodiments, uses of structures are provided including Formulas IB and IC, wherein m=0, R¹ is H, R² is F, R⁶ is alkanoyl, R¹² is R³², R³² is —P(O)R²⁰R²⁰, R¹³ is H, and B is phenyl.

In some embodiments, uses of structures are provided including Formulas IB and IC, wherein m=0, R¹ and R² are joined to form a 3 membered ring, R⁶ is alkanoyl, R¹² is R³², R³² is —P(O)R²⁰R²⁰, R¹³ is H, and B is phenyl.

In some embodiments, uses of structures are provided including Formulas IB and IC, wherein m=0, R¹ is H, R² is F, R⁶ is amide, R¹² is R³², R³² is —P(O)R²⁰R²⁰, R¹³ is H, and B is phenyl.

In some embodiments, uses of structures are provided including Formulas IB and IC, wherein m=0, R¹ and R² are joined to form a 3 membered ring, R⁶ is amide, R¹² is R³², R³² is —P(O)R²⁰R²⁰, R¹³ is H, and B is phenyl.

In some embodiments, uses of structures are provided including Formulas IB and IC, wherein m=0, R¹ is H, R² is F, R⁶ is alkanoyl, R¹² is H, R¹³ is R³², R³² is —P(O)R²⁰R²⁰, and B is phenyl.

In some embodiments, uses of structures are provided including Formulas IB and IC, wherein m=0, R¹ and R² are joined to form a 3 membered ring, R⁶ is alkanoyl, R¹² is H, R¹³ is R³², R³² is —P(O)R²⁰R²⁰, and B is phenyl.

In some embodiments, uses of structures are provided including Formulas IB and IC, wherein m=0, R¹ is H, R² is F, R⁶ is amide, R¹² is H, R¹³ is R³², R³² is —P(O)R²⁰R²⁰, and B is phenyl.

In some embodiments, uses of structures are provided including Formulas IB and IC, wherein m=0, R¹ and R² are joined to form a 3 membered ring, R⁶ is amide, R¹² is H, R¹³ is R³², R³² is —P(O)R²⁰R²⁰, and B is phenyl.

In some embodiments, uses of structures are provided including Formulas IB and IC, wherein m=1, R¹ is H, R² is F, R⁶ is alkanoyl, R¹² is R³², R³² is —P(O)R²⁰R²⁰, R¹³ is H, and B is heteroaryl.

In some embodiments, uses of structures are provided including Formulas IB and IC, wherein m=1, R¹ and R² are joined to form a 3 membered ring, R⁶ is alkanoyl, R¹² is R³², R³² is —P(O)R²⁰R²⁰, R¹³ is H, and B is heteroaryl.

In some embodiments, uses of structures are provided including Formulas IB and IC, wherein m=1, R¹ is H, R² is F, R⁶ is amide, R¹² is R³², R³² is —P(O)R²⁰R²⁰, R¹³ is H, and B is heteroaryl.

In some embodiments, uses of structures are provided including Formulas IB and IC, wherein m=1, R¹ and R² are joined to form a 3 membered ring, R⁶ is amide, R¹² is R³², R³² is —P(O)R²⁰R²⁰, R¹³ is H, and B is heteroaryl.

In some embodiments, uses of structures are provided including Formulas IB and IC, wherein m=1, R¹ is H, R² is F, R⁶ is alkanoyl, R¹² is H, R¹³ is R³², R³² is —P(O)R²⁰R²⁰, and B is heteroaryl.

In some embodiments, uses of structures are provided including Formulas IB and IC, wherein m=1, R¹ and R² are joined to form a 3 membered ring, R⁶ is alkanoyl, R¹² is H, R¹³ is R³², R³² is —P(O)R²⁰R²⁰, and B is heteroaryl.

In some embodiments, uses of structures are provided including Formulas IB and IC, wherein m=1, R¹ is H, R² is F, R⁶ is amide, R¹² is H, R¹³ is R³², R³² is —P(O)R²⁰R²⁰, and B is heteroaryl.

In some embodiments, uses of structures are provided including Formulas IB and IC, wherein m=1, R¹ and R² are joined to form a 3 membered ring, R⁶ is amide, R¹² is H, R¹³ is R³², R³² is —P(O)R²⁰R²⁰, and B is heteroaryl.

In some embodiments, uses of structures are provided including Formulas IB and IC, wherein m=1, R¹ is H, R² is F, R⁶ is alkanoyl, R¹² is R³², R³² is —P(O)R²⁰R²⁰, R¹³ is H, and B is phenyl.

In some embodiments, uses of structures are provided including Formulas IB and IC, wherein m=1, R¹ and R² are joined to form a 3 membered ring, R⁶ is alkanoyl, R¹² is R³², R³² is —P(O)R²⁰R²⁰, R¹³ is H, and B is phenyl.

In some embodiments, uses of structures are provided including Formulas IB and IC, wherein m=1, R¹ is H, R² is F, R⁶ is amide, R¹² is R³², R³² is —P(O)R²⁰R²⁰, R¹³ is H, and B is phenyl.

In some embodiments, uses of structures are provided including Formulas IB and IC, wherein m=1, R¹ and R² are joined to form a 3 membered ring, R⁶ is amide, R¹² is R³², R³² is —P(O)R²⁰R²⁰, R¹³ is H, and B is phenyl.

In some embodiments, uses of structures are provided including Formulas IB and IC, wherein m=1, R¹ is H, R² is F, R⁶ is alkanoyl, R¹² is H, R¹³ is R³², R³² is —P(O)R²⁰R²⁰, and B is phenyl.

In some embodiments, uses of structures are provided including Formulas IB and IC, wherein m=1, R¹ and R² are joined to form a 3 membered ring, R⁶ is alkanoyl, R¹² is H, R¹³ is R³², R³² is —P(O)R²⁰R²⁰, and B is phenyl.

In some embodiments, uses of structures are provided including Formulas IB and IC, wherein m=1, R¹ is H, R² is F, R⁶ is amide, R¹² is H, R¹³ is R³², R³² is —P(O)R²⁰R²⁰, and B is phenyl.

In some embodiments, uses of structures are provided including Formulas IB and IC, wherein m=1, R¹ and R² are joined to form a 3 membered ring, R⁶ is amide, R¹² is H, R¹³ is R³², R³² is —P(O)R²⁰R²⁰, and B is phenyl.

In the above embodiments, uses of structures are provided including Formulas IB and IC, wherein R²⁰ is independently selected at each occurrence from hydroxyl, C₁-C₆alkoxy, C₁-C₆haloalkoxy, C₁-C₆alkyl, (C₃-C₇cycloalkyl)C₀-C₄alkyl-, (aryl)C₀-C₄alkyl-, —O—C₀-C₄alkyl(aryl), —O—C₀-C₄alkyl(C₃-C₇cycloalkyl), (4- to 7-membered heterocycloalkyl)C₀-C₄alkyl-O— having 1, 2, or 3 heteroatoms independently selected from N, O, and S; (5- or 6-membered unsaturated or aromatic heterocycle)C₀-C₄alkyl-O— having 1, 2, or 3 heteroatoms independently selected from N, O, and S; —O(CH₂)₂₋₄O(CH₂)₈₋₁₈, —OC(R^(20a))₂OC(O)OR^(20b), —OC(R^(20a))₂OC(O)R^(20b), an N-linked amino acid or an N-linked amino acid ester and each R²⁰ can be optionally substituted;

R^(20a) is independently selected at each occurrence from hydrogen, C₁-C₈alkyl, C₂-C₈alkenyl, C₂-C₈alkynyl, (aryl)C₀-C₄alkyl-, (aryl)C₂-C₈alkenyl- or (aryl)C₂-C₈alkynyl-; or

two R^(20a) groups can be taken together with the carbon that they are bonded to form a 3-6 membered heterocycloalkyl having 1, 2, or 3 heteroatoms independently selected from N, O, and S, or a 3-6 membered carbocyclic ring.

R^(20b) is independently selected at each occurrence from C₁-C₈alkyl, C₂-C₈alkenyl, C₂-C₈alkynyl, (aryl)C₀-C₄alkyl, (aryl)C₂-C₈alkenyl or (aryl)C₂-C₈alkynyl.

Embodiments of Formula VII

To further illustrate the invention, various embodiments of Formula VII are provided that can be used as further described in this application. In one aspect, the disclosure includes uses, as described herein, of compounds and salts of Formula VII:

wherein:

R¹, R², R^(2′), and R³ are independently selected from hydrogen, halogen, C₁-C₄alkyl, C₁-C₄alkoxy, —C₀-C₂alkylNR⁹R¹⁰, —C₀-C₄alkyl(C₃-C₇cycloalkyl), —O—C₀-C₄alkyl(C₃-C₇cycloalkyl), C₁-C₂haloalkyl, and C₁-C₂haloalkoxy;

R⁸ and R^(8′) are independently selected from hydrogen, halogen, and methyl;

R⁵ is hydrogen, hydroxyl, cyano, —COOH, C₁-C₆alkyl, C₁-C₆alkoxy, C₂-C₆alkanoyl —C₀-C₄alkyl(C₃-C₇cycloalkyl), —C(O)C₀-C₄alkyl(C₃-C₇cycloalkyl, C₁-C₂haloalkyl, or C₁-C₂haloalkoxy;

R⁶ is —C(O)CH₃, —C(O)NH₂, —C(O)CF₃, —C(O)(cyclopropyl), or -ethyl(cyanoimino); and

R¹¹ and R¹⁴ are independently selected from hydrogen, halogen, hydroxyl, amino, nitro, cyano, C₁-C₆alkyl, C₂-C₆alkenyl, C₂-C₆alkanoyl, C₁-C₆alkoxy, C₁-C₆thioalkyl, —C₀-C₄alkyl(mono- and di-C₁-C₆alkylamino), —C₀-C₄alkyl(C₃-C₇cycloalkyl), —OC₀-C₄alkyl(C₃-C₇cycloalkyl), C₁-C₂haloalkyl, and C₁-C₂haloalkoxy.

Non-limiting examples of compounds of the invention provided herein include the structures of FIG. 9.

The use of prodrugs of Formula I and Table 1 for the treatment of a disorder in a host, typically a human, wherein the disorder is selected from the group disclosed in the Detailed Description, Part IV, Section A are within the scope of the disclosure. Prodrugs of compounds selected from an embodiment of the active compound as described in the Figures are also within the scope of the disclosure. The use of prodrugs of compounds selected from an embodiment of the active compound as described in the Figures for the treatment of a disorder in a host, typically a human, wherein the disorder is selected from the group disclosed in the Detailed Description, Part IV, Section A and Section B, are also within the scope of the disclosure.

III. Pharmaceutical Preparations

Active compounds described herein can be administered to a host in need thereof as the neat chemical, but are more typically administered as a pharmaceutical composition that includes an effective amount for a host, typically a human, in need of such treatment of an active compound as described herein or its pharmaceutically acceptable salt. Thus, in one embodiment, the disclosure provides pharmaceutical compositions comprising an effective amount of compound or pharmaceutically acceptable salt together with at least one pharmaceutically acceptable carrier for any of the uses described herein. The pharmaceutical composition may contain a compound or salt as the only active agent, or, in an alternative embodiment, the compound and at least one additional active agent.

An effective amount of an active compound as described herein, or the active compound described herein in combination or alternation with, or preceded by, concomitant with or followed by another active agent, can be used in an amount sufficient to (a) inhibit the progression of a disorder mediated by the complement pathway, including an inflammatory, immune, including an autoimmune, disorder or complement Factor D related disorder; (b) cause a regression of an inflammatory, immune, including an autoimmune, disorder or complement Factor D related disorder; (c) cause a cure of an inflammatory, immune, including an autoimmune, disorder or complement Factor D related disorder; or inhibit or prevent the development of an inflammatory, immune, including an autoimmune, disorder or complement Factor D related disorder.

The exact amount of the active compound or pharmaceutical composition described herein to be delivered to the host, typically a human, in need thereof, will be determined by the health care provider to achieve the desired clinical benefit.

In certain embodiments the pharmaceutical composition is in a dosage form that contains from about 0.1 mg to about 2000 mg, from about 10 mg to about 1000 mg, from about 100 mg to about 800 mg, or from about 200 mg to about 600 mg of the active compound and optionally from about 0.1 mg to about 2000 mg, from about 10 mg to about 1000 mg, from about 100 mg to about 800 mg, or from about 200 mg to about 600 mg of an additional active agent in a unit dosage form. Examples are dosage forms with at least about 25, 50, 100, 200, 250, 300, 400, 500, 600, 700, 750, 800, 900, 1000, 1100, 1200, 1300, 1400, 1500, 1600, or 1700 mg of active compound, or its salt. In one embodiment, the dosage form has at least about 100 mg, 200 mg, 400 mg, 500 mg, 600 mg, 1000 mg, 1200 mg, or 1600 mg of active compound, or its salt. The amount of active compound in the dosage form is calculated without reference to the salt. The dosage form can be administered, for example, once a day (q.d.), twice a day (b.i.d.), three times a day (t.i.d.), four times a day (q.i.d.), once every other day (Q2d), once every third day (Q3d), as needed, or any dosage schedule that provides treatment of a disorder described herein.

The pharmaceutical composition may for example include any molar ratio of the active compound and additional active agent that achieves the desired result. For example, the pharmaceutical composition may contain a molar ratio of about 0.5:1, about 1:1, about 2:1, about 3:1 or from about 1.5:1 to about 4:1 of an additional active agent in combination with the active compound (additional active agent:active compound), or its salt, described herein. In one embodiment, the additional active agent is an anti-inflammatory or immunosuppressing agent.

Compounds disclosed herein or used as described herein may be administered orally, topically, parenterally, by inhalation or spray, sublingually, via implant, including ocular implant, transdermally, via buccal administration, rectally, as an ophthalmic solution, injection, including ocular injection, intravenous, intra-aortal, intracranial, subdermal, intraperitioneal, subcutaneous, transnasal, sublingual, intrathecal, or rectal or by other means, in dosage unit formulations containing conventional pharmaceutically acceptable carriers. For ocular delivery, the compound can be administered, as desired, for example, as a solution, suspension, or other formulation via intravitreal, intrastromal, intracameral, sub-tenon, sub-retinal, retro-bulbar, peribulbar, suprachorodial, subchorodial, chorodial, conjunctival, subconjunctival, episcleral, periocular, transscleral, retrobulbar, posterior juxtascleral, circumcorneal, or tear duct injections, or through a mucus, mucin, or a mucosal barrier, in an immediate or controlled release fashion or via an ocular device, injection, or topically administered formulation, for example a solution or suspension provided as an eye drop.

The pharmaceutical composition may be formulated as any pharmaceutically useful form, e.g., as an aerosol, a cream, a gel, a gel cap, a pill, a microparticle, a nanoparticle, an injection or infusion solution, a capsule, a tablet, a syrup, a transdermal patch, a subcutaneous patch, a dry powder, an inhalation formulation, in a medical device, suppository, buccal, or sublingual formulation, parenteral formulation, or an ophthalmic solution or suspension. Some dosage forms, such as tablets and capsules, are subdivided into suitably sized unit doses containing appropriate quantities of the active components, e.g., an effective amount to achieve the desired purpose.

Pharmaceutical compositions, and methods of manufacturing such compositions, suitable for administration as contemplated herein are known in the art. Examples of known techniques include, for example, U.S. Pat. Nos. 4,983,593, 5,013,557, 5,456,923, 5,576,025, 5,723,269, 5,858,411, 6,254,889, 6,303,148, 6,395,302, 6,497,903, 7,060,296, 7,078,057, 7,404,828, 8,202,912, 8,257,741, 8,263,128, 8,337,899, 8,431,159, 9,028,870, 9,060,938, 9,211,261, 9,265,731, 9,358,478, and 9,387,252, incorporated by reference herein.

The pharmaceutical compositions contemplated here can optionally include a carrier. Carriers must be of sufficiently high purity and sufficiently low toxicity to render them suitable for administration to the patient being treated. The carrier can be inert or it can possess pharmaceutical benefits of its own. The amount of carrier employed in conjunction with the compound is sufficient to provide a practical quantity of material for administration per unit dose of the compound. Classes of carriers include, but are not limited to binders, buffering agents, coloring agents, diluents, disintegrants, emulsifiers, fillers, flavorants, glidents, lubricants, pH modifiers, preservatives, stabilizers, surfactants, solubilizers, tableting agents, and wetting agents. Some carriers may be listed in more than one class, for example vegetable oil may be used as a lubricant in some formulations and a diluent in others. Exemplary pharmaceutically acceptable carriers include sugars, starches, celluloses, powdered tragacanth, malt, gelatin; talc, and vegetable oils. Examples of other matrix materials, fillers, or diluents include lactose, mannitol, xylitol, microcrystalline cellulose, calcium diphosphate, and starch. Examples of surface active agents include sodium lauryl sulfate and polysorbate 80. Examples of drug complexing agents or solubilizers include the polyethylene glycols, caffeine, xanthene, gentisic acid and cylodextrins. Examples of disintegrants include sodium starch gycolate, sodium alginate, carboxymethyl cellulose sodium, methyl cellulose, colloidal silicon dioxide, and croscarmellose sodium. Examples of binders include methyl cellulose, microcrystalline cellulose, starch, and gums such as guar gum, and tragacanth. Examples of lubricants include magnesium stearate and calcium stearate. Examples of pH modifiers include acids such as citric acid, acetic acid, ascorbic acid, lactic acid, aspartic acid, succinic acid, phosphoric acid, and the like; bases such as sodium acetate, potassium acetate, calcium oxide, magnesium oxide, trisodium phosphate, sodium hydroxide, calcium hydroxide, aluminum hydroxide, and the like, and buffers generally comprising mixtures of acids and the salts of said acids. Optional other active agents may be included in a pharmaceutical composition, which do not substantially interfere with the activity of the compound of the present invention.

In certain embodiments, the pharmaceutical composition for administration further includes an active compound as described herein and optionally comprises one or more of a phosphoglyceride; phosphatidylcholine; dipalmitoyl phosphatidylcholine (DPPC); dioleylphosphatidyl ethanolamine (DOPE); dioleyloxypropyltriethylammonium (DOTMA); dioleoylphosphatidylcholine; cholesterol; cholesterol ester; diacylglycerol; diacylglycerolsuccinate; diphosphatidyl glycerol (DPPG); hexanedecanol; fatty alcohol such as polyethylene glycol (PEG); polyoxyethylene-9-lauryl ether; a surface active fatty acid, such as palmitic acid or oleic acid; fatty acid; fatty acid monoglyceride; fatty acid diglyceride; fatty acid amide; sorbitan trioleate (Span®85) glycocholate; sorbitan monolaurate (Span®20); polysorbate 20 (Tween®20); polysorbate 60 (Tween®60); polysorbate 65 (Tween®65); polysorbate 80 (Tween®80); polysorbate 85 (Tween®85); polyoxyethylene monostearate; surfactin; a poloxomer; a sorbitan fatty acid ester such as sorbitan trioleate; lecithin; lysolecithin; phosphatidylserine; phosphatidylinositol; sphingomyelin; phosphatidylethanolamine (cephalin); cardiolipin; phosphatidic acid; cerebroside; dicetylphosphate; dipalmitoylphosphatidylglycerol; stearylamine; dodecylamine; hexadecyl-amine; acetyl palmitate; glycerol ricinoleate; hexadecyl sterate; isopropyl myristate; tyloxapol; poly(ethylene glycol)5000-phosphatidylethanolamine; poly(ethylene glycol)400-monostearate; phospholipid; synthetic and/or natural detergent having high surfactant properties; deoxycholate; cyclodextrin; chaotropic salt; ion pairing agent; glucose, fructose, galactose, ribose, lactose, sucrose, maltose, trehalose, cellbiose, mannose, xylose, arabinose, glucoronic acid, galactoronic acid, mannuronic acid, glucosamine, galatosamine, and neuramic acid; pullulan, cellulose, microcrystalline cellulose, hydroxypropyl methylcellulose (HPMC), hydroxycellulose (HC), methylcellulose (MC), dextran, cyclodextran, glycogen, hydroxyethylstarch, carageenan, glycon, amylose, chitosan, N,O-carboxylmethylchitosan, algin and alginic acid, starch, chitin, inulin, konjac, glucommannan, pustulan, heparin, hyaluronic acid, curdlan, and xanthan, mannitol, sorbitol, xylitol, erythritol, maltitol, and lactitol, a pluronic polymer, polyethylene, polycarbonate (e.g. poly(1,3-dioxan-2one)), polyanhydride (e.g. poly(sebacic anhydride)), polypropylfumerate, polyamide (e.g. polycaprolactam), polyacetal, polyether, polyester (e.g., polylactide, polyglycolide, polylactide-co-glycolide, polycaprolactone, polyhydroxyacid (e.g. poly((β-hydroxyalkanoate))), poly(orthoester), polycyanoacrylate, polyvinyl alcohol, polyurethane, polyphosphazene, polyacrylate, polymethacrylate, polyurea, polystyrene, and polyamine, polylysine, polylysine-PEG copolymer, and poly(ethyleneimine), poly(ethylene imine)-PEG copolymer, glycerol monocaprylocaprate, propylene glycol, Vitamin E TPGS (also known as d-α-Tocopheryl polyethylene glycol 1000 succinate), gelatin, titanium dioxide, polyvinylpyrrolidone (PVP), hydroxypropyl methyl cellulose (HPMC), hydroxypropyl cellulose (HPC), methyl cellulose (MC), block copolymers of ethylene oxide and propylene oxide (PEO/PPO), polyethyleneglycol (PEG), sodium carboxymethylcellulose (NaCMC), hydroxypropylmethyl cellulose acetate succinate (HPMCAS).

In some embodiments, the pharmaceutical preparation may include a polymer for controlled delivery of the described compounds, including, but not limited to, a pluronic polymer, polyester (e.g., polylactic acid, poly(lactic-co-glycolic acid), polycaprolactone, polyvalerolactone, poly(1,3-dioxan-2one)); polyanhydride (e.g., poly(sebacic anhydride)); polyether (e.g., polyethylene glycol); polyurethane; polymethacrylate; polyacrylate; and polycyanoacrylate. In some embodiments, the polymer may be modified with polyethylene glycol (PEG), with a carbohydrate, and/or with an acyclic polyacetal derived from a polysaccharide. See, e.g., Papisov, 2001, ACS Symposium Series, 786:301, incorporated by reference herein.

The compounds of the present invention can be formulated as particles. In one embodiment the particles are or include microparticles. In an alternative embodiment the particles are or include nanoparticles.

In an additional alternative embodiment, common techniques for preparing particles include, but are not limited to, solvent evaporation, solvent removal, spray drying, phase inversion, coacervation, and low temperature casting. Suitable methods of particle formulation are briefly described below. Pharmaceutically acceptable excipients, including pH modifying agents, disintegrants, preservatives, and antioxidants, can optionally be incorporated into the particles during particle formation.

In one embodiment, the particles are derived through a solvent evaporation method. In this method, a compound described herein (or polymer matrix and one or more compounds described herein) is dissolved in a volatile organic solvent, such as methylene chloride. The organic solution containing a compound described herein is then suspended in an aqueous solution that contains a surface active agent such as poly(vinyl alcohol). The resulting emulsion is stirred until most of the organic solvent evaporated, leaving solid nanoparticles or microparticles. The resulting nanoparticles or microparticles are washed with water and dried overnight in a lyophilizer. Nanoparticles with different sizes and morphologies can be obtained by this method.

Pharmaceutical compositions which contain labile polymers, such as certain polyanhydrides, may degrade during the fabrication process due to the presence of water. For these polymers, methods which are performed in completely or substantially anhydrous organic solvents can be used to make the particles.

Solvent removal can also be used to prepare particles of a compound that is hydrolytically unstable. In this method, the compound (or polymer matrix and one or more compounds) is dispersed or dissolved in a volatile organic solvent such as methylene chloride. This mixture is then suspended by stirring in an organic oil (such as silicon oil) to form an emulsion. Solid particles form from the emulsion, which can subsequently be isolated from the supernatant. The external morphology of spheres produced with this technique is highly dependent on the identity of the drug.

In one embodiment an active compound as described herein is administered to a patient in need thereof as particles formed by solvent removal. In another embodiment the present invention provides particles formed by solvent removal comprising a compound of the present invention and one or more pharmaceutically acceptable excipients as defined herein. In another embodiment the particles formed by solvent removal comprise a compound of the present invention and an additional therapeutic agent. In a further embodiment the particles formed by solvent removal comprise a compound of the present invention, an additional therapeutic agent, and one or more pharmaceutically acceptable excipients. In another embodiment any of the described particles formed by solvent removal can be formulated into a tablet and then coated to form a coated tablet. In an alternative embodiment the particles formed by solvent removal are formulated into a tablet but the tablet is uncoated.

In one embodiment, the particles are derived by spray drying. In this method, a compound (or polymer matrix and one or more compounds) is dissolved in an organic solvent such as methylene chloride. The solution is pumped through a micronizing nozzle driven by a flow of compressed gas, and the resulting aerosol is suspended in a heated cyclone of air, allowing the solvent to evaporate from the micro droplets, forming particles. Microparticles and nanoparticles can be obtained using this method.

In one embodiment an active compound as described herein is administered to a patient in need thereof as a spray dried dispersion (SDD). In another embodiment the present invention provides a spray dried dispersion (SDD) comprising a compound of the present invention and one or more pharmaceutically acceptable excipients as defined herein. In another embodiment the SDD comprises a compound of the present invention and an additional therapeutic agent. In a further embodiment the SDD comprises a compound of the present invention, an additional therapeutic agent, and one or more pharmaceutically acceptable excipients. In another embodiment any of the described spray dried dispersions can be coated to form a coated tablet. In an alternative embodiment the spray dried dispersion is formulated into a tablet but is uncoated.

Particles can be formed from the active compound as described herein using a phase inversion method. In this method, the compound (or polymer matrix and one or more active compounds) is dissolved in a suitable solvent, and the solution is poured into a strong non-solvent for the compound to spontaneously produce, under favorable conditions, microparticles or nanoparticles. The method can be used to produce nanoparticles in a wide range of sizes, including, for example, from nanoparticles to microparticles, typically possessing a narrow particle size distribution.

In one embodiment, an active compound as described herein is administered to a patient in need thereof as particles formed by phase inversion. In another embodiment the present invention provides particles formed by phase inversion comprising a compound of the present invention and one or more pharmaceutically acceptable excipients as defined herein. In another embodiment the particles formed by phase inversion comprise a compound of the present invention and an additional therapeutic agent. In a further embodiment the particles formed by phase inversion comprise a compound of the present invention, an additional therapeutic agent, and one or more pharmaceutically acceptable excipients. In another embodiment any of the described particles formed by phase inversion can be formulated into a tablet and then coated to form a coated tablet. In an alternative embodiment the particles formed by phase inversion are formulated into a tablet but the tablet is uncoated.

Techniques for particle formation using coacervation are known in the art, for example, as described in GB-B-929 406; GB-B-929 40 1; and U.S. Pat. Nos. 3,266,987, 4,794,000, and 4,460,563. Coacervation involves the separation of a compound (or polymer matrix and one or more compounds) solution into two immiscible liquid phases. One phase is a dense coacervate phase, which contains a high concentration of the compound, while the second phase contains a low concentration of the compound. Within the dense coacervate phase, the compound forms nanoscale or microscale droplets, which harden into particles. Coacervation may be induced by a temperature change, addition of a non-solvent or addition of a micro-salt (simple coacervation), or by the addition of another polymer thereby forming an interpolymer complex (complex coacervation).

In one embodiment an active compound as described herein is administered to a patient in need thereof as particles formed by coacervation. In another embodiment the present invention provides particles formed by coacervation comprising a compound of the present invention and one or more pharmaceutically acceptable excipients as defined herein. In another embodiment the particles formed by coacervation comprise a compound of the present invention and an additional therapeutic agent. In a further embodiment the particles formed by coacervation comprise a compound of the present invention, an additional therapeutic agent, and one or more pharmaceutically acceptable excipients. In another embodiment any of the described particles formed by coacervation can be formulated into a tablet and then coated to form a coated tablet. In an alternative embodiment the particles formed by coacervation are formulated into a tablet but the tablet is uncoated.

Methods for very low temperature casting of controlled release microspheres are described in U.S. Pat. No. 5,019,400 to Gombotz et al. In this method, the compound is dissolved in a solvent. The mixture is then atomized into a vessel containing a liquid non-solvent at a temperature below the freezing point of the drug solution which freezes the compound droplets. As the droplets and non-solvent for the compound are warmed, the solvent in the droplets thaws and is extracted into the non-solvent, hardening the microspheres.

In one embodiment, a compound of the present invention is administered to a patient in need thereof as particles formed by low temperature casting. In another embodiment the present invention provides particles formed by low temperature casting comprising a compound of the present invention and one or more pharmaceutically acceptable excipients as defined herein. In another embodiment the particles formed by low temperature casting comprise a compound of the present invention and an additional therapeutic agent. In a further embodiment the particles formed by low temperature casting comprise a compound of the present invention, an additional therapeutic agent, and one or more pharmaceutically acceptable excipients. In another embodiment any of the described particles formed by low temperature casting can be formulated into a tablet and then coated to form a coated tablet. In an alternative embodiment the particles formed by low temperature casting are formulated into a tablet but the tablet is uncoated.

In one aspect of the present invention, an effective amount of an active compound as described herein is incorporated into a nanoparticle, e.g. for convenience of delivery and/or extended release delivery. The use of materials in nanoscale provides one the ability to modify fundamental physical properties such as solubility, diffusivity, blood circulation half-life, drug release characteristics, and/or immunogenicity. A number of nanoparticle-based therapeutic and diagnostic agents have been developed for the treatment of cancer, diabetes, pain, asthma, allergy, and infections. These nanoscale agents may provide more effective and/or more convenient routes of administration, lower therapeutic toxicity, extend the product life cycle, and ultimately reduce health-care costs. As therapeutic delivery systems, nanoparticles can allow targeted delivery and controlled release.

In addition, nanoparticle-based compound delivery can be used to release compounds at a sustained rate and thus lower the frequency of administration, deliver drugs in a targeted manner to minimize systemic side effects, or to deliver two or more drugs simultaneously for combination therapy to generate a synergistic effect and suppress drug resistance. A number of nanotechnology-based therapeutic products have been approved for clinical use. Among these products, liposomal drugs and polymer-based conjugates account for a large proportion of the products. See, Zhang, L., et al., Nanoparticles in Medicine: Therapeutic Applications and Developments, Clin. Pharm. and Ther., 83(5):761-769, 2008.

Methods for producing nanoparticles are known in the art. For example, see Muller, R. H., et al., Solid lipid nanoparticles (SLN) for controlled drug delivery—a review of the state of the art, Eur. H. Pharm. Biopharm., 50:161-177, 2000; U.S. Pat. No. 8,691,750 to Consien et al.; WO 2012/145801 to Kanwar. U.S. Pat. No. 8,580,311 to Armes, S. et al.; Petros, R. A. and DeSimone, J. M., Strategies in the design of nanoparticles for therapeutic applications, Nature Reviews/Drug Discovery, vol. 9:615-627, 2010; U.S. Pat. No. 8,465,775; U.S. Pat. No. 8,444,899; U.S. Pat. No. 8,420,124; U.S. Pat. No. 8,263,129; U.S. Pat. Nos. 8,158,728; 8,268,446; Pellegrino et al., 2005, Small, 1:48; Murray et al., 2000, Ann. Rev. Mat. Sci., 30:545; and Trindade et al., 2001, Chem. Mat., 13:3843; all incorporated herein by reference. Additional methods have been described in the literature (see, e.g., Doubrow, Ed., “Microcapsules and Nanoparticles in Medicine and Pharmacy,” CRC Press, Boca Raton, 1992; Mathiowitz et al., 1987, J. Control. Release, 5:13; Mathiowitz et al., 1987, Reactive Polymers, 6:275; and Mathiowitz et al., 1988, J. Appl. Polymer Sci., 35:755; U.S. Pat. Nos. 5,578,325 and 6,007,845; P. Paolicelli et al., “Surface-modified PLGA-based Nanoparticles that can Efficiently Associate and Deliver Virus-like Particles” Nanomedicine. 5(6):843-853 (2010)), U.S. Pat. No. 5,543,158 to Gref et al., or WO publication WO2009/051837 by Von Andrian et al. Zauner et al., 1998, Adv. Drug Del. Rev., 30:97; and Kabanov et al., 1995, Bioconjugate Chem., 6:7; (PEI; Boussif et al., 1995, Proc. Natl. Acad. Sci., USA, 1995, 92:7297), and poly(amidoamine) dendrimers (Kukowska-Latallo et al., 1996, Proc. Natl. Acad. Sci., USA, 93:4897; Tang et al., 1996, Bioconjugate Chem., 7:703; and Haensler et al., 1993, Bioconjugate Chem., 4:372; Putnam et al., 1999, Macromolecules, 32:3658; Barrera et al., 1993, J. Am. Chem. Soc., 115:11010; Kwon et al., 1989, Macromolecules, 22:3250; Lim et al., 1999, J. Am. Chem. Soc., 121:5633; and Zhou et al., 1990, Macromolecules, 23:3399). Examples of these polyesters include poly(L-lactide-co-L-lysine) (Barrera et al., 1993, J. Am. Chem. Soc., 115:11010), poly(serine ester) (Zhou et al., 1990, Macromolecules, 23:3399), poly(4-hydroxy-L-proline ester) (Putnam et al., 1999, Macromolecules, 32:3658; and Lim et al., 1999, J. Am. Chem. Soc., 121:5633), and poly(4-hydroxy-L-proline ester) (Putnam et al., 1999, Macromolecules, 32:3658; and Lim et al., 1999, J. Am. Chem. Soc., 121:5633; U.S. Pat. No. 6,123,727; U.S. Pat. No. 5,804,178; U.S. Pat. No. 5,770,417; U.S. Pat. No. 5,736,372; U.S. Pat. No. 5,716,404; U.S. Pat. No. 6,095,148; U.S. Pat. No. 5,837,752; U.S. Pat. No. 5,902,599; U.S. Pat. No. 5,696,175; U.S. Pat. No. 5,514,378; U.S. Pat. No. 5,512,600; U.S. Pat. No. 5,399,665; U.S. Pat. No. 5,019,379; U.S. Pat. No. 5,010,167; U.S. Pat. No. 4,806,621; U.S. Pat. No. 4,638,045; and U.S. Pat. No. 4,946,929; Wang et al., 2001, J. Am. Chem. Soc., 123:9480; Lim et al., 2001, J. Am. Chem. Soc., 123:2460; Langer, 2000, Acc. Chem. Res., 33:94; Langer, 1999, J. Control. Release, 62:7; and Uhrich et al., 1999, Chem. Rev., 99:3181; Concise Encyclopedia of Polymer Science and Polymeric Amines and Ammonium Salts, Ed. by Goethals, Pergamon Press, 1980; Principles of Polymerization by Odian, John Wiley & Sons, Fourth Edition, 2004; Contemporary Polymer Chemistry by Allcock et al., Prentice-Hall, 1981; Deming et al., 1997, Nature, 390:386; and in U.S. Pat. Nos. 6,506,577, 6,632,922, 6,686,446, and 6,818,732; C. Astete et al., “Synthesis and characterization of PLGA nanoparticles” J. Biomater. Sci. Polymer Edn, Vol. 17, No. 3, pp. 247-289 (2006); K. Avgoustakis “Pegylated Poly(Lactide) and Poly(Lactide-Co-Glycolide) Nanoparticles: Preparation, Properties and Possible Applications in Drug Delivery” Current Drug Delivery 1:321-333 (2004); C. Reis et al., “Nanoencapsulation I. Methods for preparation of drug-loaded polymeric nanoparticles” Nanomedicine 2:8-21 (2006); P. Paolicelli et al., “Surface-modified PLGA-based Nanoparticles that can Efficiently Associate and Deliver Virus-like Particles” Nanomedicine. 5(6):843-853 (2010); U.S. Pat. No. 6,632,671 to Unger Oct. 14, 2003, all incorporated herein by reference.

In one embodiment, the polymeric particle is between about 0.1 nm to about 10000 nm, between about 1 nm to about 1000 nm, between about 10 nm and 1000 nm, between about 1 and 100 nm, between about 1 and 10 nm, between about 1 and 50 nm, between about 100 nm and 800 nm, between about 400 nm and 600 nm, or about 500 nm. In one embodiment, the microparticles are no more than about 0.1 nm, 0.5 nm, 1.0 nm, 5.0 nm, 10 nm, 25 nm, 50 nm, 75 nm, 100 nm, 150 nm, 200 nm, 250 nm, 300 nm, 400 nm, 450 nm, 500 nm, 550 nm, 600 nm, 650 nm, 700 nm, 750 nm, 800 nm, 850 nm, 900 nm, 950 nm, 1000 nm, 1250 nm, 1500 nm, 1750 nm, or 2000 nm. In some embodiments, a compound described herein may be covalently coupled to a polymer used in the nanoparticle, for example a polystyrene particle, PLGA particle, PLA particle, or other nanoparticle.

The pharmaceutical compositions can be formulated for oral administration. These compositions can contain any amount of active compound that achieves the desired result, for example between 0.1 and 99 weight % (wt. %) of the compound and usually at least about 5 wt. % of the compound. Some embodiments contain at least about 10%, 15%, 20%, 25 wt. % to about 50 wt. % or from about 5 wt. % to about 75 wt. % of the compound.

Pharmaceutical compositions suitable for rectal administration are typically presented as unit dose suppositories. These may be prepared by admixing the active compound with one or more conventional solid carriers, for example, cocoa butter, and then shaping the resulting mixture.

Pharmaceutical compositions suitable for topical application to the skin preferably take the form of an ointment, cream, lotion, paste, gel, spray, aerosol, or oil. Carriers which may be used include petroleum jelly, lanoline, polyethylene glycols, alcohols, transdermal enhancers, and combinations of two or more thereof.

Pharmaceutical compositions suitable for transdermal administration may be presented as discrete patches adapted to remain in intimate contact with the epidermis of the recipient for a prolonged period of time. Pharmaceutical compositions suitable for transdermal administration may also be delivered by iontophoresis (see, for example, Pharmaceutical Research 3 (6):318 (1986)) and typically take the form of an optionally buffered aqueous solution of the active compound. In one embodiment, microneedle patches or devices are provided for delivery of drugs across or into biological tissue, particularly the skin. The microneedle patches or devices permit drug delivery at clinically relevant rates across or into skin or other tissue barriers, with minimal or no damage, pain, or irritation to the tissue.

Pharmaceutical compositions suitable for administration to the lungs can be delivered by a wide range of passive breath driven and active power driven single/-multiple dose dry powder inhalers (DPI). The devices most commonly used for respiratory delivery include nebulizers, metered-dose inhalers, and dry powder inhalers. Several types of nebulizers are available, including jet nebulizers, ultrasonic nebulizers, and vibrating mesh nebulizers. Selection of a suitable lung delivery device depends on parameters, such as nature of the drug and its formulation, the site of action, and pathophysiology of the lung.

Additional non-limiting examples of inhalation drug delivery devices and methods include, for example, U.S. Pat. No. 7,383,837 titled “Inhalation device” (SmithKline Beecham Corporation); WO/2006/033584 titled “Powder inhaler” (Glaxo SmithKline Pharmaceuticals SA); WO/2005/044186 titled “Inhalable pharmaceutical formulations employing desiccating agents and methods of administering the same” (Glaxo Group Ltd and SmithKline Beecham Corporation); U.S. Pat. No. 9,095,670 titled “Inhalation device and method of dispensing medicament”, U.S. Pat. No. 8,205,611 titled “Dry powder inhaler” (Astrazeneca AB); WO/2013/038170 titled “Inhaler” (Astrazeneca AB and Astrazeneca UK Ltd.); US/2014/0352690 titled “Inhalation Device with Feedback System”, U.S. Pat. No. 8,910,625 and US/2015/0165137 titled “Inhalation Device for Use in Aerosol Therapy” (Vectura GmbH); U.S. Pat. No. 6,948,496 titled “Inhalers”, US/2005/0152849 titled “Powders comprising anti-adherent materials for use in dry powder inhalers”, U.S. Pat. No. 6,582,678, U.S. Pat. No. 8,137,657, US/2003/0202944, and US/2010/0330188 titled “Carrier particles for use in dry powder inhalers”, U.S. Pat. No. 6,221,338 titled “Method of producing particles for use in dry powder inhalers”, U.S. Pat. No. 6,989,155 titled “Powders”, US/2007/0043030 titled “Pharmaceutical compositions for treating premature ejaculation by pulmonary inhalation”, U.S. Pat. No. 7,845,349 titled “Inhaler”, US/2012/0114709 and U.S. Pat. No. 8,101,160 titled “Formulations for Use in Inhaler Devices”, US/2013/0287854 titled “Compositions and Uses”, US/2014/0037737 and U.S. Pat. No. 8,580,306 titled “Particles for Use in a Pharmaceutical Composition”, US/2015/0174343 titled “Mixing Channel for an Inhalation Device”, U.S. Pat. No. 7,744,855 and US/2010/0285142 titled “Method of making particles for use in a pharmaceutical composition”, U.S. Pat. No. 7,541,022, US/2009/0269412, and US/2015/0050350 titled “Pharmaceutical formulations for dry powder inhalers” (Vectura Limited).

Many methods and devices for drug delivery to the eye are known in the art. Non-limiting examples are described in the following patents and patent applications (fully incorporated herein by reference). Examples are U.S. Pat. No. 8,192,408 titled “Ocular trocar assembly” (Psivida Us, Inc.); U.S. Pat. No. 7,585,517 titled “Transcleral delivery” (Macusight, Inc.); U.S. Pat. No. 5,710,182 and U.S. Pat. No. 5,795,913 titled “Ophthalmic composition” (Santen OY); U.S. Pat. No. 8,663,639 titled “Formulations for treating ocular diseases and conditions”, U.S. Pat. No. 8,486,960 titled “Formulations and methods for vascular permeability-related diseases or conditions”, U.S. Pat. No. 8,367,097 and U.S. Pat. No. 8,927,005 titled “Liquid formulations for treatment of diseases or conditions”, U.S. Pat. No. 7,455,855 titled “Delivering substance and drug delivery system using the same” (Santen Pharmaceutical Co., Ltd.); WO/2011/050365 titled “Conformable Therapeutic Shield For Vision and Pain” and WO/2009/145842 titled “Therapeutic Device for Pain Management and Vision” (Forsight Labs, LLC); U.S. Pat. No. 9,066,779 and U.S. Pat. No. 8,623,395 titled “Implantable therapeutic device”, WO/2014/160884 titled “Ophthalmic Implant for Delivering Therapeutic Substances”, U.S. Pat. No. 8,399,006, U.S. Pat. No. 8,277,830, U.S. Pat. No. 8,795,712, U.S. Pat. No. 8,808,727, U.S. Pat. No. 8,298,578, and WO/2010/088548 titled “Posterior segment drug delivery”, WO/2014/152959 and US20140276482 titled “Systems for Sustained Intraocular Delivery of Low Solubility Compounds from a Port Delivery System Implant”, U.S. Pat. No. 8,905,963 and U.S. Pat. No. 9,033,911 titled “Injector apparatus and method for drug delivery”, WO/2015/057554 titled “Formulations and Methods for Increasing or Reducing Mucus”, U.S. Pat. No. 8,715,712 and U.S. Pat. No. 8,939,948 titled “Ocular insert apparatus and methods”, WO/2013/116061 titled “Insertion and Removal Methods and Apparatus for Therapeutic Devices”, WO/2014/066775 titled “Ophthalmic System for Sustained Release of Drug to the Eye”, WO/2015/085234 and WO/2012/019176 titled “Implantable Therapeutic Device”, WO/2012/065006 titled “Methods and Apparatus to determine Porous Structures for Drug Delivery”, WO/2010/141729 titled “Anterior Segment Drug Delivery”, WO/2011/050327 titled “Corneal Denervation for Treatment of Ocular Pain”, WO/2013/022801 titled “Small Molecule Delivery with Implantable Therapeutic Device”, WO/2012/019047 titled “Subconjunctival Implant for Posterior Segment Drug Delivery”, WO/2012/068549 titled “Therapeutic Agent Formulations for Implanted Devices”, WO/2012/019139 titled “Combined Delivery Methods and Apparatus”, WO/2013/040426 titled “Ocular Insert Apparatus and Methods”, WO/2012/019136 titled “Injector Apparatus and Method for Drug Delivery”, WO/2013/040247 titled “Fluid Exchange Apparatus and Methods” (ForSight Vision4, Inc.).

Additional non-limiting examples of how to deliver the active compounds are provided in WO/2015/085251 titled “Intracameral Implant for Treatment of an Ocular Condition” (Envisia Therapeutics, Inc.); WO/2011/008737 titled “Engineered Aerosol Particles, and Associated Methods”, WO/2013/082111 titled “Geometrically Engineered Particles and Methods for Modulating Macrophage or Immune Responses”, WO/2009/132265 titled “Degradable compounds and methods of use thereof, particularly with particle replication in non-wetting templates”, WO/2010/099321 titled “Interventional drug delivery system and associated methods”, WO/2008/100304 titled “Polymer particle composite having high fidelity order, size, and shape particles”, WO/2007/024323 titled “Nanoparticle fabrication methods, systems, and materials” (Liquidia Technologies, Inc. and the University of North Carolina at Chapel Hill); WO/2010/009087 titled “Iontophoretic Delivery of a Controlled-Release Formulation in the Eye”, (Liquidia Technologies, Inc. and Eyegate Pharmaceuticals, Inc.) and WO/2009/132206 titled “Compositions and Methods for Intracellular Delivery and Release of Cargo”, WO/2007/133808 titled “Nano-particles for cosmetic applications”, WO/2007/056561 titled “Medical device, materials, and methods”, WO/2010/065748 titled “Method for producing patterned materials”, WO/2007/081876 titled “Nanostructured surfaces for biomedical/biomaterial applications and processes thereof” (Liquidia Technologies, Inc.).

Additional non-limiting examples of methods and devices for drug delivery to the eye include, for example, WO2011/106702 and U.S. Pat. No. 8,889,193 titled “Sustained delivery of therapeutic agents to an eye compartment”, WO2013/138343 and U.S. Pat. No. 8,962,577 titled “Controlled release formulations for the delivery of HIF-1 inhibitors”, WO/2013/138346 and US2013/0272994 titled “Non-Linear Multiblock Copolymer-Drug Conjugates for the Delivery of Active Agents”, WO2005/072710 and U.S. Pat. No. 8,957,034 titled “Drug and Gene Carrier Particles that Rapidly Move Through Mucus Barriers”, WO2008/030557, US2010/0215580, US2013/0164343 titled “Compositions and Methods for Enhancing Transport Through Mucous”, WO2012/061703, US2012/0121718, and US2013/0236556 titled “Compositions and Methods Relating to Reduced Mucoadhesion”, WO2012/039979 and US2013/0183244 titled “Rapid Diffusion of Large Polymeric Nanoparticles in the Mammalian Brain”, WO2012/109363 and US2013/0323313 titled “Mucus Penetrating Gene Carriers”, WO 2013/090804 and US2014/0329913 titled “Nanoparticles with enhanced mucosal penetration or decreased inflammation”, WO2013/110028 titled “Nanoparticle formulations with enhanced mucosal penetration”, WO2013/166498 and US2015/0086484 titled “Lipid-based drug carriers for rapid penetration through mucus linings” (The Johns Hopkins University); WO2013/166385 titled “Pharmaceutical Nanoparticles Showing Improved Mucosal Transport”, US2013/0323179 titled “Nanocrystals, Compositions, And Methods that Aid Particle Transport in Mucus” (The Johns Hopkins University and Kala Pharmaceuticals, Inc.); WO/2015/066444 titled “Compositions and methods for ophthalmic and/or other applications”, WO/2014/020210 and WO/2013/166408 titled “Pharmaceutical nanoparticles showing improved mucosal transport” (Kala Pharmaceuticals, Inc.); U.S. Pat. No. 9,022,970 titled “Ophthalmic injection device including dosage control device”, WO/2011/153349 titled “Ophthalmic compositions comprising pbo-peo-pbo block copolymers”, WO/2011/140203 titled “Stabilized ophthalmic galactomannan formulations”, WO/2011/068955 titled “Ophthalmic emulsion”, WO/2011/037908 titled “Injectable aqueous ophthalmic composition and method of use therefor”, US2007/0149593 titled “Pharmaceutical Formulation for Delivery of Receptor Tyrosine Kinase Inhibiting (RTKi) Compounds to the Eye”, U.S. Pat. No. 8,632,809 titled “Water insoluble polymer matrix for drug delivery” (Alcon, Inc.).

Additional non-limiting examples of drug delivery devices and methods include, for example, US20090203709 titled “Pharmaceutical Dosage Form For Oral Administration Of Tyrosine Kinase Inhibitor” (Abbott Laboratories); US20050009910 titled “Delivery of an active drug to the posterior part of the eye via subconjunctival or periocular delivery of a prodrug”, US 20130071349 titled “Biodegradable polymers for lowering intraocular pressure”, U.S. Pat. No. 8,481,069 titled “Tyrosine kinase microspheres”, U.S. Pat. No. 8,465,778 titled “Method of making tyrosine kinase microspheres”, U.S. Pat. No. 8,409,607 titled “Sustained release intraocular implants containing tyrosine kinase inhibitors and related methods”, U.S. Pat. No. 8,512,738 and US 2014/0031408 titled “Biodegradable intravitreal tyrosine kinase implants”, US 2014/0294986 titled “Microsphere Drug Delivery System for Sustained Intraocular Release”, U.S. Pat. No. 8,911,768 titled “Methods For Treating Retinopathy With Extended Therapeutic Effect” (Allergan, Inc.); U.S. Pat. No. 6,495,164 titled “Preparation of injectable suspensions having improved injectability” (Alkermes Controlled Therapeutics, Inc.); WO 2014/047439 titled “Biodegradable Microcapsules Containing Filling Material” (Akina, Inc.); WO 2010/132664 titled “Compositions And Methods For Drug Delivery” (Baxter International Inc. Baxter Healthcare SA); US20120052041 titled “Polymeric nanoparticles with enhanced drugloading and methods of use thereof” (The Brigham and Women's Hospital, Inc.); US20140178475, US20140248358, and US20140249158 titled “Therapeutic Nanoparticles Comprising a Therapeutic Agent and Methods of Making and Using Same” (BIND Therapeutics, Inc.); U.S. Pat. No. 5,869,103 titled “Polymer microparticles for drug delivery” (Danbiosyst UK Ltd.); U.S. Pat. No. 8,628,801 titled “Pegylated Nanoparticles” (Universidad de Navarra); US2014/0107025 titled “Ocular drug delivery system” (Jade Therapeutics, LLC); U.S. Pat. No. 6,287,588 titled “Agent delivering system comprised of microparticle and biodegradable gel with an improved releasing profile and methods of use thereof”, U.S. Pat. No. 6,589,549 titled “Bioactive agent delivering system comprised of microparticles within a biodegradable to improve release profiles” (Macromed, Inc.); U.S. Pat. No. 6,007,845 and U.S. Pat. No. 5,578,325 titled “Nanoparticles and microparticles of non-linear hydrophilichydrophobic multiblock copolymers” (Massachusetts Institute of Technology); US20040234611, US20080305172, US20120269894, and US20130122064 titled “Ophthalmic depot formulations for periocular or subconjunctival administration (Novartis Ag); U.S. Pat. No. 6,413,539 titled “Block polymer” (Poly-Med, Inc.); US 20070071756 titled “Delivery of an agent to ameliorate inflammation” (Peyman); US 20080166411 titled “Injectable Depot Formulations And Methods For Providing Sustained Release Of Poorly Soluble Drugs Comprising Nanoparticles” (Pfizer, Inc.); U.S. Pat. No. 6,706,289 titled “Methods and compositions for enhanced delivery of bioactive molecules” (PR Pharmaceuticals, Inc.); and U.S. Pat. No. 8,663,674 titled “Microparticle containing matrices for drug delivery” (Surmodics).

IV. Uses of Active Compounds for Treatment of Selected Disorders

In one aspect, an active compound or its salt or composition, as described herein is used to treat a medical disorder which is an inflammatory or immune condition, a disorder mediated by the complement cascade (including a dysfunctional cascade) including a complement D-related disorder, a disorder or abnormality of a cell that adversely affects the ability of the cell to engage in or respond to normal complement activity, or an undesired complement-mediated response to a medical treatment, such as surgery or other medical procedure or a pharmaceutical or biopharmaceutical drug administration, a blood transfusion, or other allogenic tissue or fluid administration.

Section A Disorders

In one embodiment, the invention is the use of a compound of Formula I, or a pharmaceutically acceptable salt or composition thereof, as well as the compounds of Table 1, Table 2, Table 3 or an embodiment of the active compound as described in the Figures for the treatment of a disorder as described in this Section A herein.

In one embodiment, the disorder is selected from fatty liver and conditions stemming from fatty liver, such as nonalcoholic steatohepatitis (NASH), liver inflammation, cirrhosis and liver failure. In one embodiment of the present invention, a method is provided for treating fatty liver disease in a host by administering an effective amount of a compound of Formula I, Table 1, Table 2, Table 3 or an embodiment of the active compound as described in the Figures or a pharmaceutically acceptable salt thereof, optionally in a pharmaceutically acceptable carrier. In one embodiment of the present invention, a method is provided for treating nonalcoholic steatohepatitis (NASH) in a host by administering an effective amount of a compound of Formula I, Table 1, Table 2, Table 3 or an embodiment of the active compound as described in the Figures, or a pharmaceutically acceptable salt thereof, optionally in a pharmaceutically acceptable carrier.

In another embodiment, the active compound is used to modulate an immune response prior to or during surgery or other medical procedure. One non-limiting example is use in connection with acute or chronic graft versus host disease, which is a common complication as a result of allogeneic tissue transplant, and can also occur as a result of a blood transfusion.

In one embodiment, the present invention provides a method of treating or preventing dermatomyositis by administering to a host in need thereof an effective amount of a composition comprising a compound of the current invention. In one embodiment, the present invention provides a method of treating or preventing amyotrophic lateral sclerosis by administering to a host in need thereof an effective amount of a composition comprising a compound of the current invention.

In another embodiment, a method is provided for the treatment or prevention of cytokine or inflammatory reactions in response to the administration of biotherapeutics (e.g. CAR T-cell therapy or monoclonal antibody therapy) in a host by administering an effective amount of a compound of Formula I, Table 1, Table 2, Table 3 or an embodiment of the active compound as described in the Figures, or a pharmaceutically acceptable salt thereof, optionally in a pharmaceutically acceptable carrier, or a pharmaceutically acceptable salt thereof, optionally in a pharmaceutically acceptable carrier. Various types of cytokine or inflammatory reactions may occur in response to biotherapeutics. In one embodiment, the cytokine or inflammatory reaction is cytokine release syndrome. In one embodiment, the cytokine or inflammatory reaction is tumor lysis syndrome (which also leads to cytokine release). Symptoms of cytokine release syndrome range from fever, headache, and skin rashes to bronchospasm, hypotension and even cardiac arrest. Severe cytokine release syndrome is described as cytokine storm, and can be fatal. Fatal cytokine storms have been observed in response to infusion with several monoclonal antibody therapeutics. See, Abramowicz D, et al. “Release of tumor necrosis factor, interleukin-2, and gamma-interferon in serum after injection of OKT3 monoclonal antibody in kidney transplant recipients” Transplantation (1989) 47(4):606-8; Chatenoud L, et al. “In vivo cell activation following OKT3 administration. Systemic cytokine release and modulation by corticosteroids” Transplantation (1990) 49(4):697-702; and Lim L C, Koh L P, and Tan P. “Fatal cytokine release syndrome with chimeric anti-CD20 monoclonal antibody rituximab in a 71-year-old patient with chronic lymphocytic leukemia” J. Clin Oncol. (1999) 17(6):1962-3.

Also contemplated herein, is the use of a compound of Formula I, Table 1, Table 2, Table 3 or an embodiment of the active compound as described in the Figures, or a pharmaceutically acceptable salt thereof, optionally in a pharmaceutically acceptable carrier to mediate an adverse immune response in patients receiving bi-specific T-cell engagers (BiTE). A bi-specific T-cell engager directs T-cells to target and bind with a specific antigen on the surface of a cancer cell. For example, Blinatumomab (Amgen), a BiTE has recently been approved as a second line therapy in Philadelphia chromosome-negative relapsed or refractory acute lymphoblastic leukemia. Blinatumomab is given by continuous intravenous infusion in 4-week cycles. The use of BiTE agents has been associated with adverse immune responses, including cytokine release syndrome. The most significantly elevated cytokines in the CRS associated with ACT include IL-10, IL-6, and IFN-γ (Klinger et al., Immunopharmacologic response of patients with B-lineage acute lymphoblastic leukemia to continuous infusion of T cell-engaging CD19/CD3-bispecific BiTE antibody blinatumomab. Blood (2012) 119:6226-6233).

In another embodiment, the disorder is episcleritis, idiopathic episcleritis, anterior episcleritis, or posterior episcleritis. In one embodiment, the disorder is idiopathic anterior uveitis, HLA-B27 related uveitis, herpetic keratouveitis, Posner Schlossman syndrome, Fuch's heterochromic iridocyclitis, or cytomegalovirus anterior uveitis.

In yet another embodiment, the disorder is selected from:

-   (i) vitritis, sarcoidosis, syphilis, tuberculosis, or Lyme disease; -   (ii) retinal vasculitis, Eales disease, tuberculosis, syphilis, or     toxoplasmosis; -   (iii) neuroretinitis, viral retinitis, or acute retinal necrosis; -   (iv) varicella zoster virus, herpes simplex virus, cytomegalovirus,     Epstein-Barr virus, lichen planus, or Dengue-associated disease     (e.g., hemorraghic Dengue Fever); -   (v) Masquerade syndrome, contact dermatitis, trauma induced     inflammation, UVB induced inflammation, eczema, granuloma annulare,     or acne.

In an additional embodiment, the disorder is selected from:

-   (i) acute myocardial infarction, aneurysm, cardiopulmonary bypass,     dilated cardiomyopathy, complement activation during cardiopulmonary     bypass operations, coronary artery disease, restenosis following     stent placement, or percutaneous transluminal coronary angioplasty     (PTCA); -   (ii) antibody-mediated transplant rejection, anaphylactic shock,     anaphylaxis, allogenic transplant, humoral and vascular transplant     rejection, graft dysfunction, graft-versus-host disease, Graves'     disease, adverse drug reactions, or chronic graft vasculopathy; -   (iii) allergic bronchopulmonary aspergillosis, allergic neuritis,     drug allergy, radiation-induced lung injury, eosinophilic pneumonia,     radiographic contrast media allergy, bronchiolitis obliterans, or     interstitial pneumonia; -   (iv) amyotrophic lateral sclerosis, parkinsonism-dementia complex,     sporadic frontotemporal dementia, frontotemporal dementia with     Parkinsonism linked to chromosome 17, frontotemporal lobar     degeneration, tangle only dementia, cerebral amyloid angiopathy,     cerebrovascular disorder, certain forms of frontotemporal dementia,     chronic traumatic encephalopathy (CTE), PD with dementia (PDD),     argyrophilic grain dementia, dementia pugilistica, dementia with     Lewy Bodies (DLB), or multi-infarct dementia; -   (v) Creutzfeldt-Jakob disease, Huntington's disease, multifocal     motor neuropathy (MMN), prion protein cerebral amyloid angiopathy,     polymyositis, postencephalitic parkinsonism, subacute sclerosing     panencephalitis, non-Guamanian motor neuron disease with     neurofibrillary tangles, neural regeneration, or diffuse     neurofibrillary tangles with calcification.

In one embodiment, the disorder is selected from:

-   (i) atopic dermatitis, dermatitis, dermatomyositis, dermatomyositis     bullous pemphigoid, scleroderma, sclerodermatomyositis, psoriatic     arthritis, pemphigus vulgaris, cutaneous lupus, discoid lupus     erythematosus, chilblain lupus erythematosus, or lupus     erythematosus-lichen planus overlap syndrome; -   (ii) cryoglobulinemic vasculitis, mesenteric/enteric vascular     disorder, peripheral vascular disorder, antineutrophil cytoplasm     antibody (ANCA)-associated vasculitis (AAV), IL-2 induced vascular     leakage syndrome, or immune complex vasculitis; -   (iii) angioedema, low platelets (HELLP) syndrome, sickle cell     disease, platelet refractoriness, red cell casts, or typical or     infectious hemolytic uremic syndrome (tHUS); -   (iv) hematuria, hemodialysis, hemolysis, hemorrhagic shock,     immunothrombocytopenic purpura (ITP), thrombotic thrombocytopenic     purpura (TTP), idiopathic thrombocytopenic purpura (ITP),     drug-induced thrombocytopenia, autoimmune hemolytic anemia (AIHA),     azotemia, blood vessel and/or lymph vessel inflammation, rotational     atherectomy, or delayed hemolytic transfusion reaction; -   (v) British type amyloid angiopathy, Buerger's disease, bullous     pemphigoid, C1q nephropathy, cancer, or catastrophic     antiphospholipid syndrome.

In another embodiment, the disorder is selected from:

-   (i) wet AMD, dry AMD, chorioretinal degeneration, choroidal     neovascularization (CNV), choroiditis, loss of RPE function, loss of     vision (including loss of visual acuity or visual field), loss of     vision from AMD, retinal damage in response to light exposure,     retinal degeneration, retinal detachment, retinal dysfunction,     retinal neovascularization (RNV), retinopathy of prematurity, or RPE     degeneration; -   (ii) pseudophakic bullous keratopathy, symptomatic macular     degeneration related disorder, optic nerve degeneration,     photoreceptor degeneration, cone degeneration, loss of photoreceptor     cells, pars planitis, scleritis, proliferative vitreoretinopathy, or     formation of ocular drusen; -   (iii) chronic urticaria, Churg-Strauss syndrome, cold agglutinin     disease (CAD), corticobasal degeneration (CBD), cryoglobulinemia,     cyclitis, damage of the Bruch's membrane, Degos disease, diabetic     angiopathy, elevated liver enzymes, endotoxemia, epidermolysis     bullosa, or epidermolysis bullosa acquisita; -   (iv) essential mixed cryoglobulinemia, excessive blood urea     nitrogen-BUN, focal segmental glomerulosclerosis,     Gerstmann-Straussler-Scheinker disease, giant cell arteritis, gout,     Hallervorden-Spatz disease, Hashimoto's thyroiditis,     Henoch-Schonlein purpura nephritis, or abnormal urinary sediments; -   (v) hepatitis, hepatitis A, hepatitis B, hepatitis C or human     immunodeficiency virus (HIV), -   (vi) a viral infection more generally, for example selected from     Flaviviridae, Retroviruses, Coronaviridae, Poxviridae, Adenoviridae,     Herpesviridae, Caliciviridae, Reoviridae, Picornaviridae,     Togaviridae, Orthomyxoviridae, Rhabdoviridae, or Hepadnaviridae; -   (vii) Neisseria meningitidis, shiga toxin E. coli-related hemolytic     uremic syndrome (STEC-HUS), Streptococcus, or poststreptococcal     glomerulonephritis.

In a further embodiment, the disorder is selected from:

-   (viii) hyperlipidemia, hypertension, hypoalbuminemia, hypobolemic     shock, hypocomplementemic urticarial vasculitis syndrome,     hypophosphastasis, hypovolemic shock, idiopathic pneumonia syndrome,     or idiopathic pulmonary fibrosis; -   (ix) inclusion body myositis, intestinal ischemia, iridocyclitis,     iritis, juvenile chronic arthritis, Kawasaki's disease (arteritis),     or lipiduria; -   (x) membranoproliferative glomerulonephritis (MPGN) I, microscopic     polyangiitis, mixed cryoglobulinemia, molybdenum cofactor deficiency     (MoCD) type A, pancreatitis, panniculitis, Pick's disease,     polyarteritis nodosa (PAN), progressive subcortical gliosis,     proteinuria, reduced glomerular filtration rate (GFR), or     renovascular disorder; -   (xi) multiple organ failure, multiple system atrophy (MSA), myotonic     dystrophy, Niemann-Pick disease type C, chronic demyelinating     diseases, or progressive supranuclear palsy; -   (xii) spinal cord injury, spinal muscular atrophy,     spondyloarthropathies, Reiter's syndrome, spontaneous fetal loss,     recurrent fetal loss, pre-eclampsia, synucleinopathy, Takayasu's     arteritis, post-partum thryoiditis, thyroiditis, Type I     cryoglobulinemia, Type II mixed cryoglobulinemia, Type III mixed     cryoglobulinemia, ulcerative colitis, uremia, urticaria, venous gas     embolus (VGE), or Wegener's granulomatosis;

In one embodiment, a compound described herein is useful for treating or preventing a disorder selected from autoimmune oophoritis, endometriosis, autoimmune orchitis, Ord's thyroiditis, autoimmune enteropathy, coeliac disease, Hashimoto's encephalopathy, antiphospholipid syndrome (APLS) (Hughes syndrome), aplastic anemia, autoimmune lymphoproliferative syndrome (Canale-Smith syndrome), autoimmune neutropenia, Evans syndrome, pernicious anemia, pure red cell aplasia, thrombocytopenia, adipose dolorosa (Dercum's disease), adult onset Still's disease, ankylosing spondylitis, CREST syndrome, drug-induced lupus, eosinophilic fasciitis (Shulman's syndrome), Felty syndrome, IgG4-related disease, mixed connective tissue disease (MCTD), palindromic rheumatism (Hench-Rosenberg syndrome), Parry-Romberg syndrome, Parsonage-Turner syndrome, relapsing polychondritis (Meyenburg-Altherr-Uehlinger syndrome), retroperitonial fibrosis, rheumatic fever, Schnitzler syndrome, fibromyalgia, neuromyotonia (Isaac's disease), paraneoplastic degeneration, autoimmune inner ear disease, Meniere's disease, interstitial cystitis, autoimmune pancreatitis, zika virus-related disorders, chikungunya virus-related disorders, subacute bacterial endocarditis (SBE), IgA nephropathy, IgA vasculitis, polymyalgia rheumatic, rheumatoid vasculitis, alopecia areata, autoimmune progesterone dermatitis, dermatitis herpetiformis, erythema nodosum, gestational pemphigoid, hidradenitis suppurativa, lichen sclerosus, linear IgA disease (LAD), morphea, myositis, pityriasis lichenoides et varioliformis acuta, vitiligo post-myocardial infarction syndrome (Dressler's syndrome), post-pericardiotomy syndrome, autoimmune retinopathy, Cogan syndrome, Graves opthalmopathy, ligneous conjunctivitis, Mooren's ulcer, opsoclonus myoclonus syndrome, optic neuritis, retinocochleocerebral vasculopathy (Susac's syndrome), sympathetic opthalmia, Tolosa-Hunt syndrome, interstitial lung disease, antisynthetase syndrome, Addison's disease, autoimmune polyendocrine syndrome (APS) type I, autoimmune polyendocrine syndrome (APS) type II, autoimmune polyendocrine syndrome (APS) type III, disseminated sclerosis (multiple sclerosis, pattern II), rapidly progressing glomerulonephritis (RPGN), juvenile rheumatoid arthritis, enthesitis-related arthritis, reactive arthritis (Reiter's syndrome), autoimmune hepatitis or lupoid hepatitis, primary biliary cirrhosis (PBS), primary sclerosing cholangitis, microscopic colitis, latent lupus (undifferentiated connective tissue disease (UCTD)), acute disseminated encephalomyelitis (ADEM), acute motor axonal neuropathy, anti-n-methyl-D-aspartate receptor encephalitis, Balo concentric sclerosis (Schilders disease), Bickerstaff's encephalitis, chronic inflammatory demyelinating polyneuropathy, idiopathic inflammatory demyelinating disease, Lambert-Eaton mysathenic syndrome, Oshtoran syndrome, pediatric autoimmune neuropsychiatric disorder associated with streptococcus (PANDAS), progressive inflammatory neuropathy, restless leg syndrome, stiff person syndrome, Sydenhem syndrome, transverse myelitis, lupus vasculitis, leukocytoclastic vasculitis, Microscopic Polyangiitis, polymyositis, ischemic-reperfusion injury of the eye.

In one embodiment, a method for the treatment of sickle cell in a host is provided that includes the administration of an effective amount of a compound described herein, or its salt, optionally in a pharmaceutically acceptable carrier. In one embodiment, a method for the treatment of immunothrombocytopenic purpura (ITP), thrombotic thrombocytopenic purpura (TTP), or idiopathic thrombocytopenic purpura (ITP) in a host is provided that includes the administration of an effective amount of a compound described herein, or its salt, optionally in a pharmaceutically acceptable carrier. In one embodiment, a method for the treatment of ANCA-vasculitis in a host is provided that includes the administration of an effective amount of a compound described herein, or its salt, optionally in a pharmaceutically acceptable carrier. In one embodiment, a method for the treatment of IgA nephropathy in a host is provided that includes the administration of an effective amount of a compound described herein, or its salt, optionally in a pharmaceutically acceptable carrier. In one embodiment, a method for the treatment of rapidly progressing glomerulonephritis (RPGN), in a host is provided that includes the administration of an effective amount of a compound described herein, or its salt, optionally in a pharmaceutically acceptable carrier. In one embodiment, a method for the treatment of lupus nephritis, in a host is provided that includes the administration of an effective amount of a compound described herein, or its salt, optionally in a pharmaceutically acceptable carrier. In one embodiment, a method for the treatment of hemorraghic dengue fever, in a host is provided that includes the administration of an effective amount of a compound described herein, or its salt, optionally in a pharmaceutically acceptable carrier.

Section B Disorders

The compound of Table 2 or Table 3 or their pharmaceutically acceptable salts or pharmaceutical compositions are useful for treating any of the disorders described herein. In one embodiment, the compound is useful for treating or preventing a disorder that is mediated by the complement pathway, and in particular, a pathway that is modulated by complement Factor D. In another embodiment, the compound is effective to treat the named disorder, albeit through a different mechanism.

In certain embodiments, the disorder is an inflammatory disorder, an immune disorder, an autoimmune disorder, or complement Factor D related disorders in a host. In one embodiment, the disorder is an ocular disorder or an eye disorder.

Examples of eye disorders that may be treated according to the compositions and methods disclosed herein include amoebic keratitis, fungal keratitis, bacterial keratitis, viral keratitis, onchorcercal keratitis, bacterial keratoconjunctivitis, viral keratoconjunctivitis, corneal dystrophic diseases, Fuchs' endothelial dystrophy, Sjogren's syndrome, Stevens-Johnson syndrome, autoimmune dry eye diseases, environmental dry eye diseases, corneal neovascularization diseases, post-corneal transplant rejection prophylaxis and treatment, autoimmune uveitis, infectious uveitis, anterior uveitis, posterior uveitis (including toxoplasmosis), pan-uveitis, an inflammatory disease of the vitreous or retina, endophthalmitis prophylaxis and treatment, macular edema, macular degeneration, age related macular degeneration, proliferative and non-proliferative diabetic retinopathy, hypertensive retinopathy, an autoimmune disease of the retina, primary and metastatic intraocular melanoma, other intraocular metastatic tumors, open angle glaucoma, closed angle glaucoma, pigmentary glaucoma and combinations thereof.

In a further embodiment, the disorder is selected from age-related macular degeneration, glaucoma, diabetic retinopathy, neuromyelitis optica (NMO), vasculitis, hemodialysis, blistering cutaneous diseases (including bullous pemphigoid, pemphigus, and epidermolysis bullosa), ocular cicatrical pemphigoid, uveitis, adult macular degeneration, diabetic retinopa retinitis pigmentosa, macular edema, Behcet's uveitis, multifocal choroiditis, Vogt-Koyangi-Harada syndrome, imtermediate uveitis, birdshot retino-chorioditis, sympathetic ophthalmia, ocular dicatricial pemphigoid, ocular pemphigus, nonartertic ischemic optic neuropathy, postoperative inflammation, and retinal vein occlusion, or uveitis (including Behcet's disease and other sub-types of uveitis).

In some embodiments, complement mediated diseases include ophthalmic diseases (including early or neovascular age-related macular degeneration and geographic atrophy), autoimmune diseases (including arthritis, rheumatoid arthritis), respiratory diseases, cardiovascular diseases. In other embodiments, the compounds of the invention are suitable for use in the treatment of diseases and disorders associated with fatty acid metabolism, including obesity and other metabolic disorders.

Complement mediated disorders that may be treated or prevented by the compounds of Table 2 or Table 3 include, but are not limited to:

-   (i) paroxysmal nocturnal hemoglobinuria (PNH), hereditary     angioedema, capillary leak syndrome, atypical hemolytic uremic     syndrome (aHUS), hemolytic uremic syndrome (HUS), abdominal aortic     aneurysm, hemodialysis complications, hemolytic anemia, or     hemodialysis; -   (ii) myasthenia gravis, multiple sclerosis, C3 glomerulonephritis     (C3GNs), MPGN II (dense deposit disease), neurological disorders,     Guillain Barre Syndrome, diseases of the central nervous system and     other neurodegenerative conditions, glomerulonephritis (including     membrane proliferative glomerulonephritis), SLE nephritis,     proliferative nephritis, liver fibrosis, tissue regeneration and     neural regeneration, or Barraquer-Simons Syndrome; -   (iii) inflammatory effects of sepsis, systemic inflammatory response     syndrome (SIRS), disorders of inappropriate or undesirable     complement activation, interleukin-2 induced toxicity during IL-2     therapy, inflammatory disorders, inflammation of autoimmune     diseases, system lupus erythematosus (SLE), Crohn's disease,     rheumatoid arthritis, inflammatory bowel disease, lupus nephritides,     arthritis, immune complex disorders and autoimmune diseases,     systemic lupus, or lupus erythematosus; -   (iv) ischemia/reperfusion injury (I/R injury), myocardial     infarction, myocarditis, post-ischemic reperfusion conditions,     balloon angioplasty, atherosclerosis, post-pump syndrome in     cardiopulmonary bypass or renal bypass, renal ischemia, mesenteric     artery reperfusion after aortic reconstruction, antiphospholipid     syndrome, autoimmune heart disease, ischemia-reperfusion injuries,     obesity, or diabetes; -   (v) Alzheimer's dementia, stroke, schizophrenia, traumatic brain     injury, trauma, Parkinson's disease, epilepsy, transplant rejection,     prevention of fetal loss, biomaterial reactions (e.g. in     hemodialysis, implants), hyperacute allograft rejection, xenograft     rejection, transplantation, psoriasis, burn injury, thermal injury     including burns or frostbite; -   (vi) asthma, allergy, acute respiratory distress syndrome (ARDS),     cystic fibrosis, adult respiratory distress syndrome, dyspnea,     hemoptysis, chronic obstructive pulmonary disease (COPD), emphysema,     pulmonary embolisms and infarcts, pneumonia, fibrogenic dust     diseases, inert dusts and minerals (e.g., silicon, coal dust,     beryllium, and asbestos), pulmonary fibrosis, organic dust diseases,     chemical injury (due to irritant gases and chemicals, e.g.,     chlorine, phosgene, sulfur dioxide, hydrogen sulfide, nitrogen     dioxide, ammonia, and hydrochloric acid), smoke injury, thermal     injury (e.g., burn, freeze), bronchoconstriction, hypersensitivity     pneumonitis, parasitic diseases, Goodpasture's Syndrome     (anti-glomerular basement membrane nephritis), pulmonary vasculitis,     Pauci-immune vasculitis, or immune complex-associated inflammation.

In one embodiment, a method for the treatment of paroxysmal nocturnal hemoglobinuria (PNH) is provided that includes the administration of an effective amount of a compound selected from Table 2 or Table 3, or a pharmaceutically acceptable salt thereof, optionally in a pharmaceutically acceptable carrier.

In another embodiment, a method for the treatment of age-related macular degeneration (AMD) is provided that includes the administration of an effective amount of a compound selected from Table 2 or Table 3, or a pharmaceutically acceptable salt thereof, optionally in a pharmaceutically acceptable carrier.

In another embodiment, a method for the treatment of rheumatoid arthritis is provided that includes the administration of an effective amount of a compound selected from Table 2 or Table 3, or a pharmaceutically acceptable salt thereof, optionally in a pharmaceutically acceptable carrier.

In another embodiment, a method for the treatment of multiple sclerosis is provided that includes the administration of an effective amount of a compound selected from Table 2 or Table 3, or a pharmaceutically acceptable salt thereof, optionally in a pharmaceutically acceptable carrier.

In another embodiment, a method for the treatment of myasthenia gravis is provided that includes the administration of an effective amount of a compound selected from Table 2 or Table 3, or a pharmaceutically acceptable salt thereof, optionally in a pharmaceutically acceptable carrier.

In another embodiment, a method for the treatment of atypical hemolytic uremic syndrome (aHUS) is provided that includes the administration of an effective amount of a compound selected from Table 2 or Table 3, or a pharmaceutically acceptable salt thereof, optionally in a pharmaceutically acceptable carrier.

In another embodiment, a method for the treatment of C3 glomerulonephritis is provided that includes the administration of an effective amount of a compound selected from Table 2 or Table 3, or a pharmaceutically acceptable salt thereof, optionally in a pharmaceutically acceptable carrier.

In another embodiment, a method for the treatment of abdominal aortic aneurysm is provided that includes the administration of an effective amount of a compound selected from Table 2 or Table 3, or a pharmaceutically acceptable salt thereof, optionally in a pharmaceutically acceptable carrier.

In another embodiment, a method for the treatment of neuromyelitis optica (NMO) is provided that includes the administration of an effective amount of a compound selected from Table 2 or Table 3, or a pharmaceutically acceptable salt thereof, optionally in a pharmaceutically acceptable carrier.

In some embodiments, the present invention provides methods of treating or preventing an inflammatory disorder or a complement related disease, by administering to a host in need thereof an effective amount of a compound selected from Table 2 or Table 3 of the invention. In some embodiments, the present invention provides methods of treating or preventing an inflammatory disorder more generally, an immune disorder, autoimmune disorder, or complement Factor D related disorder, by providing an effective amount of a compound or pharmaceutically acceptable salt of a compound selected from Table 2 or Table 3 to patient with a Factor D mediated inflammatory disorder. A compound selected from Table 2 or Table 3 may be provided as the only active agent or may be provided together with one or more additional active agents.

In one embodiment, a method for the treatment of a disorder associated with a dysfunction in the complement cascade is provided that includes the administration of an effective amount of a compound selected from Table 2 or Table 3, or a pharmaceutically acceptable salt thereof, optionally in a pharmaceutically acceptable carrier. In one embodiment, a method of inhibiting activation of the alternative complement pathway in a host is provided that includes the administration of an effective amount of a compound selected from Table 2 or Table 3, or a pharmaceutically acceptable salt thereof, optionally in a pharmaceutically acceptable carrier. In one embodiment, a method of modulating Factor D activity in a host is provided that includes the administration of an effective amount of a compound selected from Table 2 or Table 3, or a pharmaceutically acceptable salt thereof, optionally in a pharmaceutically acceptable carrier.

In an additional alternative embodiment, the compound selected from Table 2 or Table 3, or a pharmaceutically acceptable salt thereof, optionally in a pharmaceutically acceptable carrier is used in the treatment of an autoimmune disorder.

The complement pathway enhances the ability of antibodies and phagocytic cells to clear microbes and damaged cells from the body. It is part of the innate immune system and in healthy individuals is an essential process. Inhibiting the complement pathway will decrease the body's immune system response. Therefore, it is an object of the present invention to treat autoimmune disorders by administering an effective does of a compound of Table 2 or Table 3, or a pharmaceutically acceptable salt thereof, optionally in a pharmaceutically acceptable carrier, to a host in need thereof.

In one embodiment the autoimmune disorder is caused by activity of the complement system. In one embodiment the autoimmune disorder is caused by activity of the alternative complement pathway. In one embodiment the autoimmune disorder is caused by activity of the classical complement pathway. In another embodiment the autoimmune disorder is caused by a mechanism of action that is not directly related to the complement system, such as the over-proliferation of T-lymphocytes or the over-production of cytokines.

Non-limiting examples of autoimmune disorders include: allograft rejection, autoimmune thyroid diseases (such as Graves' disease and Hashimoto's thyroiditis), autoimmune uveoretinitis, giant cell arteritis, inflammatory bowel diseases (including Crohn's disease, ulcerative colitis, regional enteritis, granulomatous enteritis, distal ileitis, regional ileitis, and terminal ileitis), diabetes, multiple sclerosis, pernicious anemia, psoriasis, rheumatoid arthritis, sarcoidosis, and scleroderma.

In one embodiment, a compound selected from Table 2 or Table 3, or a pharmaceutically acceptable salt thereof, optionally in a pharmaceutically acceptable carrier, is used in the treatment of lupus. Non-limiting examples of lupus include lupus erythematosus, cutaneous lupus, discoid lupus erythematosus, chilblain lupus erythematosus, lupus erythematosus-lichen planus overlap syndrome.

Lupus erythematosus is a generic category of disease that includes both systemic and cutaneous disorders. The systemic form of the disease can have cutaneous as well as systemic manifestations. However, there are also forms of the disease that are only cutaneous without systemic involvement. For example, SLE is an inflammatory disorder of unknown etiology that occurs predominantly in women, and is characterized by articular symptoms, butterfly erythema, recurrent pleurisy, pericarditis, generalized adenopathy, splenomegaly, as well as CNS involvement and progressive renal failure. The sera of most patients (over 98%) contain antinuclear antibodies, including anti-DNA antibodies. High titers of anti-DNA antibodies are essentially specific for SLE. Conventional treatment for this disease has been the administration of corticosteroids or immunosuppressants.

There are three forms of cutaneous lupus: chronic cutaneous lupus (also known as discoid lupus erythematosus or DLE), subacute cutaneous lupus, and acute cutaneous lupus. DLE is a disfiguring chronic disorder primarily affecting the skin with sharply circumscribed macules and plaques that display erythema, follicular plugging, scales, telangiectasia and atrophy. The condition is often precipitated by sun exposure, and the early lesions are erythematous, round scaling papules that are 5 to 10 mm in diameter and display follicular plugging. DLE lesions appear most commonly on the cheeks, nose, scalp, and ears, but they may also be generalized over the upper portion of the trunk, extensor surfaces of the extremities, and on the mucous membranes of the mouth. If left untreated, the central lesion atrophies and leaves a scar. Unlike SLE, antibodies against double-stranded DNA (e.g., DNA-binding test) are almost invariably absent in DLE.

Multiple sclerosis is an autoimmune demyelinating disorder that is believed to be T lymphocyte dependent. MS generally exhibits a relapsing-remitting course or a chronic progressive course. The etiology of MS is unknown, however, viral infections, genetic predisposition, environment, and autoimmunity all appear to contribute to the disorder. Lesions in MS patients contain infiltrates of predominantly T lymphocyte mediated microglial cells and infiltrating macrophages. CD4+T lymphocytes are the predominant cell type present at these lesions. The hallmark of the MS lesion is plaque, an area of demyelination sharply demarcated from the usual white matter seen in MRI scans. Histological appearance of MS plaques varies with different stages of the disease. In active lesions, the blood-brain barrier is damaged, thereby permitting extravasation of serum proteins into extracellular spaces. Inflammatory cells can be seen in perivascular cuffs and throughout white matter. CD4+ T-cells, especially Th1, accumulate around postcapillary venules at the edge of the plaque and are also scattered in the white matter. In active lesions, up-regulation of adhesion molecules and markers of lymphocyte and monocyte activation, such as IL2-R and CD26 have also been observed. Demyelination in active lesions is not accompanied by destruction of oligodendrocytes. In contrast, during chronic phases of the disease, lesions are characterized by a loss of oligodendrocytes and hence, the presence of myelin oligodendrocyte glycoprotein (MOG) antibodies in the blood.

Diabetes can refer to either type 1 or type 2 diabetes. In one embodiment a compound of Table 2 or Table 3 or a pharmaceutically acceptable salt thereof, optionally in a pharmaceutically acceptable carrier, is provided at an effective dose to treat a patient with type 1 diabetes. In one embodiment a compound of Table 2 or Table 3, or a pharmaceutically acceptable salt thereof, optionally in a pharmaceutically acceptable carrier, is provided at an effective dose to treat a patient with type 2 diabetes.

Type 1 diabetes is an autoimmune disease. An autoimmune disease results when the body's system for fighting infection (the immune system) turns against a part of the body. The pancreas then produces little or no insulin.

V. Combination Therapy

In additional embodiments, an effective amount of an active compound or its salt or composition as described herein may be provided in combination or alternation with or preceded by, concomitant with or followed by, an effective amount of at least one additional therapeutic agent, for example, for treatment of a disorder listed herein. Non-limiting examples of additional therapeutic agents for such combination therapy are provided below.

In one embodiment, an effective amount of an active compound or its salt or composition as described herein may be provided in combination or alternation with an effective amount of at least one additional inhibitor of the complement system or a second active compound with a different biological mechanism of action. In the description below and herein generally, whenever any of the terms referring to an active compound or its salt or composition as described herein are used, it should be understood that pharmaceutically acceptable salts, prodrugs or compositions are considered included, unless otherwise stated or inconsistent with the text.

In non-limiting embodiments, an active compound or its salt or composition as described herein may be provided together with a protease inhibitor, a soluble complement regulator, a therapeutic antibody (monoclonal or polyclonal), complement component inhibitor, receptor agonist, or siRNA.

In other embodiments, an active compound described herein is administered in combination or alternation with an antibody against tumor necrosis factor (TNF), including but not limited to infliximab (Remicade), adalimumab, certolizumab, golimumab, or a receptor fusion protein such as etanercept (Embrel).

In another embodiment, an active compound as described herein can be administered in combination or alternation with an anti-CD20 antibody, including but not limited to rituximab (Rituxan), adalimumab (Humira), ofatumumab (Arzerra), tositumomab (Bexxar), obinutuzumab (Gazyva), or ibritumomab (Zevalin).

In an alternative embodiment, an active compound as described herein can be administered in combination or alternation with an anti-IL6 antibody, including but not limited to tocilizumab (Actemra) and siltuximab (Sylvant).

In an alternative embodiment, an active compound as described herein can be administered in combination or alternation with an IL17 inhibitor, including but not limited to secukibumab (Cosentyx).

In an alternative embodiment, an active compound as described herein can be administered in combination or alternation with a p40 (IL12/IL23) inhibitor, including but not limited to ustekinumab (Stelara).

In an alternative embodiment, an active compound as described herein can be administered in combination or alteration with an IL23 inhibitor, including but not limited to risankizumab.

In an alternative embodiment, an active compound as described herein can be administered in combination or alteration with an anti-interferon α antibody, for example but not limited to sifalimumab.

In an alternative embodiment, an active compound as described herein can be administered in combination or alteration with a kinase inhibitor, for example but not limited to a JAK1/JAK3 inhibitor, for example but not limited to tofacitinib (Xelianz). In an alternative embodiment, an active compound as described herein can be administered in combination or alteration with a JAK1/JAK2 inhibitor, for example but not limited to baracitibib.

In another embodiment, an active compound as described herein can be administered in combination or alternation with an immune checkpoint inhibitor. Non-limiting examples of checkpoint inhibitors are anti-PD-1 or anti-PDL1 antibodies (for example, Nivolumab, Pembrolizumab, Pidilizumab and Atezolizumab) and anti-CTLA4 antibodies (Ipilimumab and Tremelimumab).

Non-limiting examples of active agents that can be used in combination with active compounds described herein are:

Protease inhibitors: plasma-derived C1-INH concentrates, for example Cetor® (Sanquin), Berinert-P® (CSL Behring, Lev Pharma), and Cinryze®; recombinant human C1-inhibitors, for example Rhucin®; ritonavir (Norvir®, Abbvie, Inc.);

Soluble complement regulators: Soluble complement receptor 1 (TP10) (Avant Immunotherapeutics); sCR1-sLex/TP-20 (Avant Immunotherapeutics); MLN-2222/CAB-2 (Millenium Pharmaceuticals); Mirococept (Inflazyme Pharmaceuticals);

Therapeutic antibodies: Eculizumab/Soliris (Alexion Pharmaceuticals); Pexelizumab (Alexion Pharmaceuticals); Ofatumumab (Genmab A/S); TNX-234 (Tanox); TNX-558 (Tanox); TA106 (Taligen Therapeutics); Neutrazumab (G2 Therapies); Anti-properdin (Novelmed Therapeutics); HuMax-CD38 (Genmab A/S);

Complement component inhibitors: Compstatin/POT-4 (Potentia Pharmaceuticals); ARC1905 (Archemix);

Receptor agonists: PMX-53 (Peptech Ltd.); JPE-137 (Jerini); JSM-7717 (Jerini);

Others: Recombinant human MBL (rhMBL; Enzon Pharmaceuticals).

Imides and glutarimide derivatives such as thalidomide, lenalidomide, pomalidomide;

Additional non-limiting examples that can be used in combination or alternation with an active compound or its salt or composition as described herein include the following.

Non-limiting examples of potential therapeutics for combination therapy Name Target Company Class of Molecule LFG316 C5 Novartis/Morphosys Monoclonal antibody 4(1MEW)APL-1, APL-2 C3/C3b Apella Compstatin Family 4(1MeW)POT-4 C3/C3b Potentia Compstatin Family Anti-C5 siRNA C5 Alnylam Si-RNA Anti-FB siRNA CFB Alnylam SiRNA ARC1005 C5 Novo Nordisk Aptamers ATA C5 N.A. Chemical Coversin C5 Volution Immuno- Small animal protein Pharmaceuticals CP40/AMY-101, C3/C3b Amyndas Compstatin Family PEG-Cp40 CRIg/CFH CAP C3 NA CFH-based protein convertase Cynryze C1n/C1s ViroPharma/Baxter Human purified protein FCFD4514S CFD Genentech/Roche Monoclonal antibody H17 C3 (C3b/iC3b) EluSys Therapeutics Monoclonal antibody Mini-CFH CAP C3 Amyndas CFH-based protein convertase Mirococept (APT070) CAP and CCP NA CR1-based protein C3 Mubodine C5 Adienne Monoclonal antibody RA101348 C5 Rapharma Small molecule sCR1 (CDX-1135) CAP and CP C3 Celldex CR1-based protein SOBI002 C5 Swedish Orphan Biovitrum Affibody SOMAmers C5 SomaLogic Aptamers SOMAmers CFB and CFD SomaLogic Aptamers (SELEX) TA106 CFB Alexion Pharmaceuticals Monoclonal antibody TNT003 C1s True North Monoclonal antibody TT30 (CR2/CFH) CAP C3 Alexion CFH-based protein convertase TT32 (CR2/CR1) CAP and CCP C3 Alexion Pharmaceuticals CR1-based protein Nafamostat (FUT-175, C1s, CFD, other Torri Pharmaceuticals Small molecule Futhan) proteases OMS721 MASP-2 Omeros Monoclonal antibody OMS906 MASP-2 Omeros Monoclonal antibody Bikaciomab, NM9308 CFB Novelmed Monoclonal antibody NM9401 Properdin Novelmed Monoclonal antibody CVF, HC-1496 C3 InCode Recombinant peptide ALXN1102/ALXN1103 C3-conv, C3b Alexion Pharmaceuticals Regulator (TT30) rFH C3-conv, C3b Optherion Regulator 5C6, AMY-301 CFH Amyndas Regulator Erdigna C5 Adienne Pharma Antibody ARC1905 C5 Opthotech Monoclonal Antibody MEDI7814 C5/C5a MedImmune Monoclonal Antibody NOX-D19 C5a Noxxon Aptamer (Spiegelmer) IFX-1, CaCP29 C5a InflaRx Monoclonal Antibody PMX53, PMX205 C5aR Cephalon, Teva Peptidomimetic CCX168 C5aR ChemoCentryx Small molecule ADC-1004 C5aR Alligator Bioscience Small molecule Anti-C5aR-151, C5aR Novo Nordisk Monoclonal Antibody NN8209; Anti-C5aR- 215, NN8210 Imprime PGG CR3 Biothera Soluble beta-glucan

In one embodiment, an active compound or its salt or composition as described herein may be provided together with a compound that inhibits an enzyme that metabolizes an administered protease inhibitor. In one embodiment, a compound or salt may be provided together with ritonavir.

In one embodiment, an active compound or its salt or composition as described herein may be provided in combination with a complement C5 inhibitor or C5 convertase inhibitor. In another embodiment, an active compound or its salt or composition as described herein may be provided in combination with eculizumab, a monoclonal antibody directed to the complement factor C5 and manufactured and marketed by Alexion Pharmaceuticals under the tradename Soliris. Eculizumab has been approved by the U.S. FDA for the treatment of PNH and aHUS.

In one embodiment, an active compound or its salt or composition as described herein may be provided together with a compound that inhibits complement factor D. In one embodiment of the invention, an active compound or its salt or composition as described herein as described herein can be used in combination or alternation with a compound described in Biocryst Pharmaceuticals U.S. Pat. No. 6,653,340 titled “Compounds useful in the complement, coagulate and kallikrein pathways and method for their preparation” describes fused bicyclic ring compounds that are potent inhibitors of Factor D; Novartis PCT patent publication WO2012/093101 titled “Indole compounds or analogues thereof useful for the treatment of age-related macular degeneration” describes certain Factor D inhibitors; Novartis PCT patent publications WO2014/002051, WO2014/002052, WO2014/002053, WO2014/002054, WO2014/002057, WO2014/002058, WO2014/002059, WO2014/005150, WO2014/009833, WO 2013/164802, WO 2015/009616, WO 2015/066241, Bristol-Myers Squibb PCT patent publication WO2004/045518 titled “Open chain prolyl urea-related modulators of androgen receptor function”; Japan Tobacco Inc. PCT patent publication WO1999/048492 titled “Amide derivatives and nociceptin antagonists”; Ferring B. V. and Yamanouchi Pharmaceutical Co. LTD. PCT patent publication WO1993/020099 titled “CCK and/or gastrin receptor ligands”; Alexion Pharmaceuticals PCT patent publication WO1995/029697 titled “Methods and compositions for the treatment of glomerulonephritis and other inflammatory diseases”; or Achillion Pharmaceuticals filed PCT Patent Application No. PCT/US2015/017523 and U.S. patent application Ser. No. 14/631,090 titled “Alkyne Compounds for Treatment of Complement Mediated Disorders”; PCT Patent Application No. PCT/US2015/017538 and U.S. patent application Ser. No. 14/631,233 titled “Amide Compounds for Treatment of Complement Mediated Disorders”; PCT Patent Application No. PCT/US2015/017554 and U.S. patent application Ser. No. 14/631,312 titled “Amino Compounds for Treatment of Complement Mediated Disorders”; PCT Patent Application No. PCT/US2015/017583 and U.S. patent application Ser. No. 14/631,440 titled “Carbamate, Ester, and Ketone Compounds for Treatment of Complement Mediated Disorders”; PCT Patent Application No. PCT/US2015/017593 and U.S. patent application Ser. No. 14/631,625 titled “Aryl, Heteroaryl, and Heterocyclic Compounds for Treatment of Complement Mediated Disorders”; PCT Patent Application No. PCT/US2015/017597 and U.S. patent application Ser. No. 14/631,683 titled “Ether Compounds for Treatment of Complement Mediated Disorders”; PCT Patent Application No. PCT/US2015/017600 and U.S. patent application Ser. No. 14/631,785 titled “Phosphonate Compounds for Treatment of Complement Mediated Disorders”; and PCT Patent Application No. PCT/US2015/017609 and U.S. patent application Ser. No. 14/631,828 titled “Compounds for Treatment of Complement Mediated Disorders.”

In one embodiment, an active compound or its salt or composition as described herein is administered in combination with an anti-inflammatory drug, antimicrobial agent, anti-angiogenesis agent, immunosuppressant, antibody, steroid, ocular antihypertensive drug or combinations thereof. Examples of such agents include amikacin, anecortane acetate, anthracenedione, anthracycline, an azole, amphotericin B, bevacizumab, camptothecin, cefuroxime, chloramphenicol, chlorhexidine, chlorhexidine digluconate, clortrimazole, a clotrimazole cephalosporin, corticosteroids, dexamethasone, desamethazone, econazole, eftazidime, epipodophyllotoxin, fluconazole, flucytosine, fluoropyrimidines, fluoroquinolines, gatifloxacin, glycopeptides, imidazoles, itraconazole, ivermectin, ketoconazole, levofloxacin, macrolides, miconazole, miconazole nitrate, moxifloxacin, natamycin, neomycin, nystatin, ofloxacin, polyhexamethylene biguanide, prednisolone, prednisolone acetate, pegaptanib, platinum analogues, polymicin B, propamidine isethionate, pyrimidine nucleoside, ranibizumab, squalamine lactate, sulfonamides, triamcinolone, triamcinolone acetonide, triazoles, vancomycin, anti-vascular endothelial growth factor (VEGF) agents, VEGF antibodies, VEGF antibody fragments, vinca alkaloid, timolol, betaxolol, travoprost, latanoprost, bimatoprost, brimonidine, dorzolamide, acetazolamide, pilocarpine, ciprofloxacin, azithromycin, gentamycin, tobramycin, cefazolin, voriconazole, gancyclovir, cidofovir, foscarnet, diclofenac, nepafenac, ketorolac, ibuprofen, indomethacin, fluoromethalone, rimexolone, anecortave, cyclosporine, methotrexate, tacrolimus and combinations thereof.

In one embodiment of the present invention, an active compound or its salt or composition as described herein can be administered in combination or alternation with at least one immunosuppressive agent. The immunosuppressive agent as non-limiting examples, may be a calcineurin inhibitor, e.g. a cyclosporin or an ascomycin, e.g. Cyclosporin A (NEORAL®), FK506 (tacrolimus), pimecrolimus, a mTOR inhibitor, e.g. rapamycin or a derivative thereof, e.g. Sirolimus (RAPAMUNE®), Everolimus (Certican®), temsirolimus, zotarolimus, biolimus-7, biolimus-9, a rapalog, e.g.ridaforolimus, azathioprine, campath 1H, a S1P receptor modulator, e.g. fingolimod or an analogue thereof, an anti IL-8 antibody, mycophenolic acid or a salt thereof, e.g. sodium salt, or a prodrug thereof, e.g. Mycophenolate Mofetil (CELLCEPT®), OKT3 (ORTHOCLONE OKT3®), Prednisone, ATGAM®, THYMOGLOBULIN®, Brequinar Sodium, OKT4, T10B9.A-3A, 33B3.1, 15-deoxyspergualin, tresperimus, Leflunomide ARAVA®, CTLAI-Ig, anti-CD25, anti-IL2R, Basiliximab (SIMULECT®), Daclizumab (ZENAPAX®), mizorbine, methotrexate, dexamethasone, ISAtx-247, SDZ ASM 981 (pimecrolimus, Elidel®), CTLA4lg (Abatacept), belatacept, LFA3lg, etanercept (sold as Enbrel® by Immunex), adalimumab (Humira®), infliximab (Remicade®), an anti-LFA-1 antibody, natalizumab (Antegren®), Enlimomab, gavilimomab, antithymocyte immunoglobulin, siplizumab, Alefacept efalizumab, pentasa, mesalazine, asacol, codeine phosphate, benorylate, fenbufen, naprosyn, diclofenac, etodolac and indomethacin, tocilizumab (Actemra), siltuximab (Sylvant), secukibumab (Cosentyx), ustekinumab (Stelara), risankizumab, sifalimumab, aspirin and ibuprofen.

Examples of anti-inflammatory agents include methotrexate, dexamethasone, dexamethasone alcohol, dexamethasone sodium phosphate, fluromethalone acetate, fluromethalone alcohol, lotoprendol etabonate, medrysone, prednisolone acetate, prednisolone sodium phosphate, difluprednate, rimexolone, hydrocortisone, hydrocortisone acetate, lodoxamide tromethamine, aspirin, ibuprofen, suprofen, piroxicam, meloxicam, flubiprofen, naproxan, ketoprofen, tenoxicam, diclofenac sodium, ketotifen fumarate, diclofenac sodium, nepafenac, bromfenac, flurbiprofen sodium, suprofen, celecoxib, naproxen, rofecoxib, glucocorticoids, diclofenac, and any combination thereof. In one embodiment, an active compound or its salt or composition as described herein is combined with one or more non-steroidal anti-inflammatory drugs (NSAIDs) selected from naproxen sodium (Anaprox), celecoxib (Celebrex), sulindac (Clinoril), oxaprozin (Daypro), salsalate (Disalcid), diflunisal (Dolobid), piroxicam (Feldene), indomethacin (Indocin), etodolac (Lodine), meloxicam (Mobic), naproxen (Naprosyn), nabumetone (Relafen), ketorolac tromethamine (Toradol), naproxen/esomeprazole (Vimovo), and diclofenac (Voltaren), and combinations thereof.

In one embodiment, an active compound or its salt or composition as described herein is administered in combination or alteration with an omega-3 fatty acid or a peroxisome proliferator-activated receptor (PPARs) agonist. Omega-3 fatty acids are known to reduce serum triglycerides by inhibiting DGAT and by stimulating peroxisomal and mitochondrial beta oxidation. Two omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have been found to have high affinity for both PPAR-alpha and PPAR-gamma. Marine oils, e.g., fish oils, are a good source of EPA and DHA, which have been found to regulate lipid metabolism. Omega-3 fatty acids have been found to have beneficial effects on the risk factors for cardiovascular diseases, especially mild hypertension, hypertriglyceridemia and on the coagulation factor VII phospholipid complex activity. Omega-3 fatty acids lower serum triglycerides, increase serum HDL-cholesterol, lower systolic and diastolic blood pressure and the pulse rate, and lower the activity of the blood coagulation factor VII-phospholipid complex. Further, omega-3 fatty acids seem to be well tolerated, without giving rise to any severe side effects. One such form of omega-3 fatty acid is a concentrate of omega-3, long chain, polyunsaturated fatty acids from fish oil containing DHA and EPA and is sold under the trademark Omacor®. Such a form of omega-3 fatty acid is described, for example, in U.S. Pat. Nos. 5,502,077, 5,656,667 and 5,698,594, the disclosures of which are incorporated herein by reference.

Peroxisome proliferator-activated receptors (PPARs) are members of the nuclear hormone receptor superfamily ligand-activated transcription factors that are related to retinoid, steroid and thyroid hormone receptors. There are three distinct PPAR subtypes that are the products of different genes and are commonly designated PPAR-alpha, PPAR-beta/delta (or merely, delta) and PPAR-gamma. General classes of pharmacological agents that stimulate peroxisomal activity are known as PPAR agonists, e.g., PPAR-alpha agonists, PPAR-gamma agonists and PPAR-delta agonists. Some pharmacological agents are combinations of PPAR agonists, such as alpha/gamma agonists, etc., and some other pharmacological agents have dual agonist/antagonist activity. Fibrates such as fenofibrate, bezafibrate, clofibrate and gemfibrozil, are PPAR-alpha agonists and are used in patients to decrease lipoproteins rich in triglycerides, to increase HDL and to decrease atherogenic-dense LDL. Fibrates are typically orally administered to such patients. Fenofibrate or 2-[4-(4-chlorobenzoyl)phenoxy]-2-methyl-propanoic acid, 1-methylethyl ester, has been known for many years as a medicinally active principle because of its efficacy in lowering blood triglyceride and cholesterol levels.

In one embodiment, the present invention provides a method of treating or preventing age-related macular degeneration (AMD) by administering to a host in need thereof an effective amount of an active compound or its salt or composition as described herein in combination with an anti-VEGF agent. Non-limiting examples of anti-VEGF agents include, but are not limited to, aflibercept (Eylea®; Regeneron Pharmaceuticals); ranibizumab (Lucentis®: Genentech and Novartis); and pegaptanib (Macugen®; OSI Pharmaceuticals and Pfizer); Bevacizumab (Avastin; Genentech/Roche); anecortane acetate, squalamine lactate, and corticosteroids, including, but not limited to, triamcinolone acetonide.

In one embodiment, the present invention provides a method of treating or preventing paroxysmal nocturnal hemoglobinuria (PNH) by administering to a host in need thereof an effective amount of an active compound or its salt or composition as described herein with an additional inhibitor of the complement system or another active compound with a different biological mechanism of action. In another embodiment, the present invention provides a method of treating or preventing paroxysmal nocturnal hemoglobinuria (PNH) by administering to a host in need thereof an effective amount of an active compound or its salt or composition as described herein in combination or alternation with eculizumab. In another embodiment, the present invention provides a method of treating or preventing paroxysmal nocturnal hemoglobinuria (PNH) by administering to a host in need thereof an effective amount of an active compound or its salt or composition as described herein in combination or alternation with CP40. In one embodiment, the additional agent is PEGylated-CP40. CP40 is a peptide inhibitor that shows a strong binding affinity for C3b and inhibits hemolysis of paroxysmal nocturnal hemoglobinuria (PNH) erythrocytes.

In one embodiment, the present invention provides a method of treating or preventing rheumatoid arthritis by administering to a host in need thereof an effective amount of a composition comprising an active compound or its salt or composition as described herein in combination or alternation with an additional inhibitor of the complement system, or an active agent that functions through a different mechanism of action. In another embodiment, the present invention provides a method of treating or preventing rheumatoid arthritis by administering to a host in need thereof an effective amount of an active compound or its salt or composition as described herein in combination or alternation with methotrexate. In certain embodiments, an active compound or its salt or composition as described herein is administered in combination or alternation with at least one additional therapeutic agent selected from: salicylates including aspirin (Anacin, Ascriptin, Bayer Aspirin, Ecotrin) and salsalate (Mono-Gesic, Salgesic); nonsteroidal anti-inflammatory drugs (NSAIDs); nonselective inhibitors of the cyclo-oxygenase (COX-1 and COX-2) enzymes, including diclofenac (Cataflam, Voltaren), ibuprofen (Advil, Motrin), ketoprofen (Orudis), naproxen (Aleve, Naprosyn), piroxicam (Feldene), etodolac (Lodine), indomethacin, oxaprozin (Daypro), nabumetone (Relafen), and meloxicam (Mobic); selective cyclo-oxygenase-2 (COX-2) inhibitors including Celecoxib (Celebrex); disease-modifying antirheumatic drugs (DMARDs), including azathioprine (Imuran), cyclosporine (Sandimmune, Neoral), gold salts (Ridaura, Solganal, Aurolate, Myochrysine), hydroxychloroquine (Plaquenil), leflunomide (Arava), methotrexate (Rheumatrex), penicillamine (Cuprimine), and sulfasalazine (Azulfidine); biologic drugs including abatacept (Orencia), etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), and anakinra (Kineret); corticosteroids including betamethasone (Celestone Soluspan), cortisone (Cortone), dexamethasone (Decadron), methylprednisolone (SoluMedrol, DepoMedrol), prednisolone (Delta-Cortef), prednisone (Deltasone, Orasone), and triamcinolone (Aristocort); gold salts, including Auranofin (Ridaura); Aurothioglucose (Solganal); Aurolate; Myochrysine; or any combination thereof.

In one embodiment, the present invention provides a method of treating or preventing multiple sclerosis by administering to a host in need thereof an effective amount of an active compound or its salt or composition as described herein in combination or alternation with an additional inhibitor of the complement system, or an active agent that functions through a different mechanism of action. In another embodiment, the present invention provides a method of treating or preventing multiple sclerosis by administering to a host in need thereof an effective amount of an active compound or its salt or composition as described herein in combination or alternation with a corticosteroid. Examples of corticosteroids include, but are not limited to, prednisone, dexamethasone, solumedrol, and methylprednisolone. In one embodiment, an active compound or its salt or composition as described herein is combined with at least one anti-multiple sclerosis drug, for example, selected from: Aubagio (teriflunomide), Avonex (interferon beta-1a), Betaseron (interferon beta-1b), Copaxone (glatiramer acetate), Extavia (interferon beta-1b), Gilenya (fingolimod), Lemtrada (alemtuzumab), Novantrone (mitoxantrone), Plegridy (peginterferon beta-1a), Rebif (interferon beta-1a), Tecfidera (dimethyl fumarate), Tysabri (natalizumab), Solu-Medrol (methylpredni solone), High-dose oral Deltasone (prednisone), H.P. Acthar Gel (ACTH), or a combination thereof.

In one embodiment, an active compound or its salt or composition as described herein is useful in a combination with another pharmaceutical agent to ameliorate or reduce a side effect of the agent. For example, in one embodiment, an active compound or its salt or composition as described herein may be used in combination with adoptive cell transfer therapies to reduce an associated inflammatory response associated with such therapies, for example, a cytokine mediated response such as cytokine release syndrome. In one embodiment, the adoptive cell transfer therapy includes the use of a chimeric antigen receptor T-Cell (CAR T). In one embodiment, the adoptive cell transfer therapy includes the use of a chimeric antigen receptor T-Cell (CAR T) or a dendritic cell to treat a hematologic or solid tumor, for example, a B-cell related hematologic cancer. In one embodiment, the hematologic or solid tumor is acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), non-Hodgkin's lymphoma, chronic lymphocytic leukemia (CLL), pancreatic cancer, glioblastoma, or a cancer that expresses CD19.

In an additional alternative embodiment, an active compound or its salt or composition as described herein may be provided in combination with eculizumab for the treatment of PNH, aHUSs, STEC-HUS, ANCA-vasculitis, AMD, CAD, chronic hemolysis, neuromyelitis optica, or transplantation rejection. In one embodiment, an active compound or its salt or composition as described herein may be provided in combination with compstatin or a compstatin derivative for the treatment of PNH, aHUSs, STEC-HUS, ANCA-vasculitis, AMD, CAD, chronic hemolysis, neuromyelitis optica, or transplantation rejection.

In one embodiment, an active compound or its salt or composition as described herein may be provided in combination with rituxan for the treatment of a complement mediated disorder. In one embodiment, the complement mediated disorder is, for example, rheumatoid arthritis, Granulomatosis with Polyangiitis (GPA) (Wegener's Granulomatosis), and Microscopic Polyangiitis (MPA). In one embodiment, the disorder is Lupus.

In one embodiment, an active compound or its salt or composition as described herein may be provided in combination with cyclophosphamide for the treatment of a complement mediated disorder. In one embodiment, the disorder is an autoimmune disease. In one embodiment, the complement mediated disorder is, for example, rheumatoid arthritis, Granulomatosis with Polyangiitis (GPA) (Wegener's Granulomatosis), and Microscopic Polyangiitis (MPA). In one embodiment, the disorder is Lupus.

In one embodiment, an active compound or its salt or composition as described herein is dosed in combination with a conventional DLE treatment for the treatment of lupus to a host in need thereof.

Examples of conventional DLE treatments include topical corticosteroid ointments or creams, such as triamcinolone acetonide, fluocinolone, flurandrenolide, betamethasone valerate, or betamethasone dipropionate. Resistant plaques can be injected with an intradermal corticosteroid. Other potential DLE treatments include calcineurin inhibitors such as pimecrolimus cream or tacrolimus ointment. Particularly resistant cases can be treated with systemic antimalarial drugs, such as hydroxychloroquine (PLAQUENIL).

In one embodiment, an active compound or its salt or composition as described herein may be provided in combination with methotrexate for the treatment of Lupus.

In one embodiment, an active compound or its salt or composition as described herein may be provided in combination with azathioprine for the treatment of Lupus.

In one embodiment, an active compound or its salt or composition as described herein may be provided in combination with a non-steroidal anti-inflammatory drug for the treatment of Lupus.

In one embodiment, an active compound or its salt or composition as described herein may be provided in combination with a corticosteroid for the treatment of Lupus.

In one embodiment, an active compound or its salt or composition as described herein may be provided in combination with a belimumab (Benlysta) for the treatment of Lupus.

In one embodiment, an active compound or its salt or composition as described herein may be provided in combination with hydroxychloroquine (Plaquenil) for the treatment of Lupus.

In one embodiment, an active compound or its salt or composition as described herein may be provided in combination with sifalimumab for the treatment of Lupus.

In one embodiment, an active compound or its salt or composition as described herein may be provided in combination with OMS721 (Omeros) for the treatment of a complement mediated disorder. In one embodiment, an active compound or its salt or composition as described herein may be provided in combination with OMS906 (Omeros) for the treatment of a complement mediated disorder. In one embodiment, the complement mediated disorder is, for example, thrombotic thrombocytopenic purpura (TTP) or aHUS.

In one embodiment, an active compound or its salt or composition as described herein may be provided in combination with an anti-inflammatory agent, immunosuppressive agent, or anti-cytokine agent for the treatment or prevention of cytokine or inflammatory reactions in response to the administration of biotherapeutics (e.g. adoptive T-cell therapy (ACT) such as CAR T-cell therapy, or monoclonal antibody therapy). In one embodiment, an active compound or its salt or composition as described herein may be provided in combination with a corticosteroid, for example prednisone, dexamethasone, solumedrol, and methylprednisolone, and/or anti-cytokine compounds targeting, e.g., IL-4, IL-10, IL-11, IL-13 and TGFβ. In one embodiment, an active compound or its salt or composition as described herein may be provided in combination with an anti-cytokine inhibitor including, but are not limited to, adalimumab, infliximab, etanercept, protopic, efalizumab, alefacept, anakinra, siltuximab, secukibumab, ustekinumab, golimumab, and tocilizumab, or a combination thereof. Additional anti-inflammatory agents that can be used in combination with an active compound or its salt or composition as described herein include, but are not limited to, non-steroidal anti-inflammatory drug(s) (NSAIDs); cytokine suppressive anti-inflammatory drug(s) (CSAIDs); CDP-571/BAY-10-3356 (humanized anti-TNFα antibody; Celltech/Bayer); cA2/infliximab (chimeric anti-TNFα antibody; Centocor); 75 kdTNFR-IgG/etanercept (75 kD TNF receptor-IgG fusion protein; Immunex); 55 kdTNF-IgG (55 kD TNF receptor-IgG fusion protein; Hoffmann-LaRoche); IDEC-CE9.1/SB 210396 (non-depleting primatized anti-CD4 antibody; IDEC/SmithKline); DAB 486-IL-2 and/or DAB 389-IL-2 (IL-2 fusion proteins; Seragen); Anti-Tac (humanized anti-IL-2Rα; Protein Design Labs/Roche); IL-4 (anti-inflammatory cytokine; DNAX/Schering); IL-10 (SCH 52000; recombinant IL-10, anti-inflammatory cytokine; DNAX/Schering); IL-4; IL-10 and/or IL-4 agonists (e.g., agonist antibodies); IL-1RA (IL-1 receptor antagonist; Synergen/Amgen); anakinra (Kineret®/Amgen); TNF-bp/s-TNF (soluble TNF binding protein); R973401 (phosphodiesterase Type IV inhibitor); MK-966 (COX-2 Inhibitor); Iloprost, leflunomide (anti-inflammatory and cytokine inhibiton); tranexamic acid (inhibitor of plasminogen activation); T-614 (cytokine inhibitor); prostaglandin E1; Tenidap (non-steroidal anti-inflammatory drug); Naproxen (non-steroidal anti-inflammatory drug); Meloxicam (non-steroidal anti-inflammatory drug); Ibuprofen (non-steroidal anti-inflammatory drug); Piroxicam (non-steroidal anti-inflammatory drug); Diclofenac (non-steroidal anti-inflammatory drug); Indomethacin (non-steroidal anti-inflammatory drug); Sulfasalazine; Azathioprine; ICE inhibitor (inhibitor of the enzyme interleukin-1β converting enzyme); zap-70 and/or lck inhibitor (inhibitor of the tyrosine kinase zap-70 or lck); TNF-convertase inhibitors; anti-IL-12 antibodies; anti-IL-18 antibodies; interleukin-11; interleukin-13; interleukin-17 inhibitors; gold; penicillamine; chloroquine; chlorambucil; hydroxychloroquine; cyclosporine; cyclophosphamide; anti-thymocyte globulin; anti-CD4 antibodies; CD5-toxins; orally-administered peptides and collagen; lobenzarit disodium; Cytokine Regulating Agents (CRAB) HP228 and HP466 (Houghten Pharmaceuticals, Inc.); ICAM-1 antisense phosphorothioate oligo-deoxynucleotides (ISIS 2302; Isis Pharmaceuticals, Inc.); soluble complement receptor 1 (TP10; T Cell Sciences, Inc.); prednisone; orgotein; glycosaminoglycan polysulphate; minocycline; anti-IL2R antibodies; marine and botanical lipids (fish and plant seed fatty acids); auranofin; phenylbutazone; meclofenamic acid; flufenamic acid; intravenous immune globulin; zileuton; azaribine; mycophenolic acid (RS-61443); tacrolimus (FK-506); sirolimus (rapamycin); amiprilose (therafectin); cladribine (2-chlorodeoxyadenosine).

In a specific embodiment, an active compound or its salt or composition as described herein may be provided in combination with a corticosteroid for the treatment or prevention of cytokine or inflammatory reactions in response to the administration of biotherapeutics. In another embodiment, an active compound or its salt or composition as described herein may be provided in combination with etarnercept for the treatment or prevention of cytokine or inflammatory reactions in response to the administration of biotherapeutics. In another embodiment, an active compound or its salt or composition as described herein may be provided in combination with tocilizumab for the treatment or prevention of cytokine or inflammatory reactions in response to the administration of biotherapeutics. In another embodiment, an active compound or its salt or composition as described herein may be provided in combination with etarnercept and tocilizumab for the treatment or prevention of cytokine or inflammatory reactions in response to the administration of biotherapeutics. In another embodiment, an active compound or its salt or composition as described herein may be provided in combination with infliximab for the treatment or prevention of cytokine or inflammatory reactions in response to the administration of biotherapeutics. In another embodiment, an active compound or its salt or composition as described herein may be provided in combination with golimumab for the treatment or prevention of cytokine or inflammatory reactions in response to the administration of biotherapeutics.

VI. Combinations for Prophylactic or Concommitant Anti-Bacterial Therapy

In one aspect of the present invention, a method is provided for treating a host in need thereof that comprises administering an effective amount of a prophylactic anti-bacterial vaccine prior to administration of an active compound or its salt or composition for any of the disorders described herein. In another aspect of the present invention, a method is provided for treating a host in need thereof that comprises administering an effective amount of a prophylactic anti-bacterial drug, such as a pharmaceutical drug, prior to administration of an active compound or its salt or composition for any of the disorders described herein. In one aspect of the present invention, a method is provided for treating a host in need thereof that comprises administering an effective amount of an anti-bacterial vaccine after administration of an active compound or its salt or composition for any of the disorders described herein. In another aspect of the present invention, a method is provided for treating a host in need thereof that comprises administering an effective amount of an anti-bacterial drug, such as a pharmaceutical drug, after administration of an active compound or its salt or composition for any of the disorders described herein. In one embodiment, the disorder is PNH or aHUS. In one embodiment, the host has received an organ or other tissue or biological fluid transplant. In one embodiment, the host is also administered eculizumab.

In one aspect of the present invention, an active compound or its salt or composition as described herein is administered to a host concomitantly with the prophylactic administration of a vaccine against a bacterial infection. In one embodiment, the complement mediated disorder is PNH or aHUS. In one embodiment, the host has received an organ or other tissue or biological fluid transplant. In one embodiment, the host is also administered eculizumab.

In one aspect of the present invention, an active compound or its salt or composition as described herein is administered to a host and, during the administration period of the compound or salt, a vaccine against a bacterial infection is administered to the host. In one embodiment, the disorder is PNH or aHUS. In one embodiment, the host has received an organ or other tissue or biological fluid transplant. In one embodiment, the host is also administered eculizumab.

In one aspect of the present invention, the host is administered an active compound or its salt or composition as described herein in combination with an antibiotic compound for the duration of factor D inhibitor administration. In one embodiment, the disorder is PNH or aHUS. In one embodiment, the host has received an organ or other tissue or biological fluid transplant. In one embodiment, the host is also administered eculizumab.

In one aspect of the present invention, an active compound or its salt or composition as described herein is administered to a host following the prophylactic administration of a vaccine against a bacterial infection, and in combination with an antibiotic compound for the duration of factor D inhibitor administration. In one embodiment, the complement mediated disorder is PNH or aHUS. In one embodiment, the host has received an organ or other tissue or biological fluid transplant. In one embodiment, the host is also administered eculizumab.

In one embodiment, the host, prior to receiving an active compound or its salt or composition as described herein, is vaccinated against a bacterial infection caused by the bacterium Neisseria meningitidis. In one embodiment, the host is vaccinated against a bacterial infection caused by the bacterium Haemophilus influenzae. In one embodiment, the Haemophilus influenzae is Haemophilus influenzae serotype B (Hib). In one embodiment, the host is vaccinated against a bacterial infection caused by Streptococcus pneumoniae. In one embodiment, the host is vaccinated against a bacterial infection caused by the bacterium Nisseria meningitidis, Haemophilus influenzae, or Streptococcus pneumoniae, or a combination of one or more of Nisseria meningitidis, Haemophilus influenzae, or Streptococcus pneumoniae. In one embodiment, the host is vaccinated against a bacterial infection caused by the bacterium Nisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae.

In other embodiments, the host is vaccinated against a bacterial infection caused by a bacterium selected from a Gram-negative bacterium. In one embodiment, the host is vaccinated against a bacterial infection caused by a bacterium selected from a Gram-positive bacterium. In one embodiment, the host is vaccinated against a bacterial infection caused by the bacterium Nisseria meningitidis, Haemophilus influenzae, or Streptococcus pneunemoniae, or a combination of one or more of Nisseria meningitidis, Haemophilus influenzae, or Streptococcus pneumoniae, and one or more of, but not limited to, Bacillus anthracis, Bordetella pertussis, Clostridium tetani, Corynebacterium diphtheria, Coxiella burnetii, Mycobacterium tuberculosis, Salmonella typhi, Vibrio cholerae, Anaplasma phagocytophilum, Ehrlichia ewingii, Ehrlichia chaffeensis, Ehrlichia canis, Neorickettsia sennetsu, Mycobacterium leprae, Borrelia burgdorferi, Borrelia mayonii, Borrelia afzelii, Borrelia garinii, Mycobacterium bovis, Staphylococcus aureus, Streptococcus pyogenes, Treponema pallidum, Francisella tularensis, Yersinia pestis,

In one embodiment, the host is vaccinated with one or more vaccines selected from, but not limited to, typhoid vaccine, live (Vivotif Berna Vaccine, PaxVax), typhoid Vi polysaccharide vaccine (Typhim Vi, Sanofi), pneumococcal 23-polyvalent vaccine, PCV13 (Pneumovax 23, Merck), pneumococcal 7-valent vaccine, PCV7 (Prevnar, Pfizer), pneumococcal 13-valent vaccine, PCV13 (Prevnar 13, Pfizer), haemophilus b conjugate (prp-t) vaccine (ActHIB, Sanofi; Hibrix, GSK), haemophilus b conjugate (hboc) vaccine (HibTITER, Neuron Biotech), haemophilus b conjugate (prp-omp) vaccine (PedvaxHIB, Merck), haemophilus b conjugate (prp-t) vaccine/meningococcal conjugate vaccine (MenHibrix, GSK), haemophilus b conjugate (prp-t) vaccine/meningococcal conjugate vaccine/Hepatitis B vaccine (Comvax, Merck), meningococcal polysaccharide vaccine (Menomune A/C/Y/W-135, Sanofi), meningococcal conjugate vaccine/diphtheria CRM197 conjugate (Menveo, GSK; Menactra, Sanofi), meningococcal group B vaccine (Bexsero, GSK; Trumenba, Pfizer), anthrax vaccine adsorbed (Biothrax, Emergent Biosolutions), tetanus toxoid (Te Anatoxal Berna, Hendricks Regional Health), Bacillus Calmette and Guérin, live, intravesical (TheraCys, Sanofi; Tice BCG, Organon), cholera vaccine, live, oral (Vachora, Sanofi; Dukoral, SBL Vaccines; ShanChol, Shantha Biotec; Micromedex, Truven Health), tetanus toxoids and diphtheria absorbed (Tdap; Decavac, Sanofi; Tenivac, Sanofi; td, Massachusetts Biological Labs), diphtheria and tetanus toxois and pertussis (DTap; Daptacel, Sanofi; Infanrix, GSK; Tripedia, Sanofi), diphtheria and tetanus toxois and pertussis/polio (Kinrix, GSK; Quadracel, Sanofi), diphtheria and tetanus toxois and pertussis tetanus/hepatitis B/polio (Pediarix, GSK), diphtheria and tetanus toxois and pertussis/polio, haemophilus influenza tybe b (Pentacel, Sanofi), and/or diphtheria, and pertussis (Tdap; Boostrix, GSK; Adacel, Sanofi), or a combination thereof.

As described above, a host receiving a compound of the present invention to treat disorder is prophylactically administered an antibiotic compound in addition to a factor D inhibitor described herein. In one embodiment, the host is administered an antibiotic compound for the duration of administration of the active compound to reduce the development of a bacterial infection. Antibiotic compounds for concomitant administration with a factor D inhibitor described herein can be any antibiotic useful in preventing or reducing the effect of a bacterial infection. Antibiotics are well known in the art and include, but are not limited to, amikacin (Amikin), gentamicin (Garamycin), kanamycin (Kantrex), neomycin (Neo-Fradin), netilmicin (Netromycin), tobramycin (Nebcin), paromomycin (Humatin), streptomycin, spectinomycin (Trobicin), geldanamycin, herbimycin, rifaximin (Xifaxan), loracarbef (Lorabid), ertapenem (Invanz), doripenem (Doribax), imipenem/cilastatin (Primaxin), meropenem (Merrem), cefadroxil (Duricef), cefazolin (Ancef), cefalotin/cefalothin (Keflin), cephalexin (Keflex), cefaclor (Distaclor), cefamandole (Mandol), cefoxitin (Mefoxin), cefprozil (Cefzil), cefuroxime (Ceftin, Zinnat), cefixime (Cefspan), cefdinir (Omnicef, Cefdiel), cefditoren (Spectracef, Meiact), cefoperazone (Cefobid), cefotaxime (Claforan), cefpodoxime (Vantin) ceftazidime (Fortaz), ceftibuten (Cedax), ceftizoxime (Cefizox), ceftriaxone (Rocephin), cefepime (Maxipime), ceftaroline fosamil (Teflaro), ceftobiprole (Zeftera), teicoplanin (Targocid), vancomycin (Vancocin), telavancin (Vibativ), dalbavancin (Dalvance), oritavancin (Orbactiv), clindamycin (Cleocin), lincomycin (Lincocin), daptomycin (Cubicin), azithromycin (Zithromax, Sumamed, Xithrone), clarithromycin (Biaxin), dirithromycin (Dynabac), erythromycin (Erythocin, Erythroped), roxithromycin, troleandomycin (Tao), telithromycin (Ketek), spiramycin (Rovamycine), aztreonam (Azactam), furazolidone (Furoxone), nitrofurantoin (Macrodantin, Macrobid), linezolid (Zyvox), posizolid, radezolid, torezolid, amoxicillin (Novamox, Amoxil), ampicillin (Principen), azlocillin, carbenicillin (Geocillin), cloxacillin (Tegopen), dicloxacillin (Dynapen), flucloxacillin (Floxapen), mezlocillin (Mezlin), methicillin (Staphcillin), nafcillin (Unipen), oxacillin (Prostaphlin), penicillin G (Pentids), penicillin V (Veetids (Pen-Vee-K), piperacillin (Pipracil), penicillin G (Pfizerpen), temocillin (Negaban), ticarcillin (Ticar), amoxicillin/clavulanate (Augmentin), ampicillin/sulbactam (Unasyn), piperacillin/tazobactam (Zosyn), ticarcillin/clavulanate (Timentin), bacitracin, colistin (Coly-Mycin-S), polymyxin B, ciprofloxacin (Cipro, Ciproxin, Ciprobay), enoxacin (Penetrex), gatifloxacin (Tequin), gemifloxacin (Factive), levofloxacin (Levaquin), lomefloxacin (Maxaquin), moxifloxacin (Avelox), nalidixic acid (NegGram), norfloxacin (Noroxin), ofloxacin (Floxin, Ocuflox), trovafloxacin (Trovan), grepafloxacin (Raxar), sparfloxacin (Zagam), temafloxacin (Omniflox), mafenide (Sulfamylon), sulfacetamide (Sulamyd, Bleph-10), sulfadiazine (Micro-Sulfon), silver sulfadiazine (Silvadene), sulfadimethoxine (Di-Methox, Albon), sulfamethizole (Thiosulfil Forte), sulfamethoxazole (Gantanol), sulfanilamide, sulfasalazine (Azulfidine), sulfisoxazole (Gantrisin), trimethoprim-sulfamethoxazole (Co-trimoxazole) (TMP-SMX) (Bactrim, Septra), sulfonamidochrysoidine (Prontosil), demeclocycline (Declomycin), doxycycline (Vibramycin), minocycline (Minocin), oxytetracycline (Terramycin), tetracycline (Sumycin, Achromycin V, Steclin), clofazimine (Lamprene), dapsone (Avlosulfon), capreomycin (Capastat), cycloserine (Seromycin), ethambutol (Myambutol), ethionamide (Trecator), isoniazid (I.N.H.), pyrazinamide (Aldinamide), rifampicin (Rifadin, Rimactane), rifabutin (Mycobutin), rifapentine (Priftin), streptomycin, arsphenamine (Salvarsan), chloramphenicol (Chloromycetin), fosfomycin (Monurol, Monuril), fusidic acid (Fucidin), metronidazole (Flagyl), mupirocin (Bactroban), platensimycin, quinupristin/dalfopristin (Synercid), thiamphenicol, tigecycline (Tigacyl), tinidazole (Tindamax Fasigyn), trimethoprim (Proloprim, Trimpex), and/or teixobactin, or a combination thereof.

In one embodiment, the host is administered a prophylactic antibiotic selected from cephalosporin, for example, ceftriaxone or cefotaxime, ampicillin-sulbactam, Penicillin G, ampicillin, chloramphenicol, fluoroquinolone, aztreonam, levofloxacin, moxifloxacin, gemifloxacin, vancomycin, clindamycin, cefazolin, azithromycin, meropenem, ceftaroline, tigecycline, clarithromycin, moxifloxacin, trimethoprim/sulfamethoxazole, cefuroxime, axetil, ciprofloxacin, rifampin, minocycline, spiramycin, and cefixime, or a combination of two or more thereof.

VII. Process of Preparation of Compounds of Formula I Abbreviations

-   (Boc)₂O di-tert-butyl dicarbonate -   AcCl acetyl chloride -   ACN Acetonitrile -   AcOEt, EtOAc ethyl acetate -   AcOH acetic acid -   CH₃OH, MeOH Methanol -   CsF Cesium fluoride -   CuI Cuprous iodide -   DCM, CH₂Cl₂ Dichloromethane -   DIEA, DIPEA N,N-diisopropylethylamine -   DMA N,N-dimethylacetamide -   DMF N,N-dimethylformamide -   DMSO Dimethylsulfoxide -   DPPA Diphenyl phosphoryl azide -   Et₃N, TEA Triethylamine -   EtOAc Ethylacetate -   EtOH Ethanol -   FA formic acid -   HATU     1-[Bis(dimethylamino)methylene]-1H-1,2,3-triazolo[4,5-b]pyridinium     3-oxide hexafluorophosphate -   HCl Hydrochloric acid -   ^(i)Pr₂NEt N,N-diisopropylethylamine -   K₂CO₃ Potassium carbonate -   LiOH Lithium hydroxide -   MTBE Methyl ^(t)butylether -   Na₂SO₄ Sodium sulfate -   NaCl Sodium chloride -   NaH Sodium hydride -   NaHCO₃ Sodium bicarbonate -   NEt₃ Trimethylamine -   Pd(OAc)₂ Palaldium acetate -   Pd(dppf)Cl₂ [1,1′-Bis(diphenylphosphino)     ferrocene]dichloropalladium(II) -   Pd(PPh₃)₂Cl₂ Bis(triphenylphosphine)palladium(II) dichloride -   Pd(PPh₃)₄ Tetrakis(triphenylphosphine)palladium(0) -   Pd₂ (dba)₃ Tris(dibenzylideneacetone)dipalladium(0) -   PPh₃ Triphenylphosphine -   RT Room temperature -   tBuOK potassium tert-butoxide -   TEA Trimethylamine -   Tf₂O trifluoromethanesulfonic anhydride -   TFA Trifluoroacetic acid -   THF Tetrahydrofuran -   TMSBr bromotrimethylsilane -   t_(R) Retention time -   Zn (CN)₂ Zinc cyanide     General Methods

All nonaqueous reactions were performed under an atmosphere of dry argon or nitrogen gas using anhydrous solvents. The progress of reactions and the purity of target compounds were determined using one of the two liquid chromatography (LC) methods listed below. The structure of starting materials, intermediates, and final products was confirmed by standard analytical techniques, including NMR spectroscopy and mass spectrometry.

LC Method A

Instrument: Waters Acquity Ultra Performance LC

Column: ACQUITY UPLC BEH C18 2.1×50 mm, 1.7 μm

Column Temperature: 40° C.

Mobile Phase: Solvent A: H₂O+0.05% FA; Solvent B: CH₃CN+0.05% FA

Flow Rate: 0.8 mL/min

Gradient: 0.24 min @ 15% B, 3.26 min gradient (15-85% B), then 0.5 min @ 85% B.

Detection: UV (PDA), ELS, and MS (SQ in EI mode)

LC Method B

Instrument: Shimadzu LC-2010A HT

Column: Athena, C18-WP, 50×4.6 mm, 5 μm

Column Temperature: 40° C.

Mobile Phase: Solvent A: H₂O/CH₃OH/FA=90/10/0.1; Solvent B: H₂O/CH₃OH/FA=10/90/0.1

Flow Rate: 3 mL/min

Gradient: 0.4 min @ 30% B, 3.4 min gradient (30-100% B), then 0.8 min @ 100% B

Detection: UV (220/254 nm)

LC Method C

Instrument: Agilent 1100/1200 series LC system with DAD detector

Column: Atlantis dC18 (250×4.6) mm, 5 μm

Column Temperature: Ambient

Mobile Phase A: 0.1% TFA in water, Mobile Phase B: Acetonitrile

Flow Rate: 1.0 mL/min

Gradient:

Time (min) 0.0 15 20 23 30 % B 10 100 100 10 10

Detection: (210-400 nm)

LC Method D

Instrument: Shimadzu LC 20AD system with PDA detector

Column: Phenomenex Gemini NX C18 (150×4.6) mm, 5 μm

Column Temperature: Ambient

Mobile Phase A: 10 mM NH₄OAC in water, Mobile Phase B: Acetonitrile

Flow Rate: 1.0 mL/min

Gradient:

Time (min) 0.0 15 20 23 30 % B 10 100 100 10 10

Detection: (210-400 nm)

Example 1. General Route of Synthesis

A compound of the present invention can be prepared, for example, from a central core. In one embodiment, for example, the central core Structure 1 is an N-protected aminoacid where X¹ is nitrogen and PG=protecting group. In one embodiment, the central core is coupled to an amine to generate an amide of Structure 2 (wherein L-B includes a C(O)N moiety). Structure 2 can then be deprotected to generate Structure 3. Structure 3 is coupled to Structure 4 (A-COOH) to generate a second amide bond, forming a compound within Formula I. The chemistry is illustrated in Route 1.

Route 1

In an alternative embodiment, central core Structure 5 is reacted with a heterocyclic or heteroaryl compound to generate a compound of Structure 6. In one embodiment, Structure 6 is deprotected to generate a carboxylic acid, Structure 7. In one embodiment, Structure 7 is coupled to an amine to generate a compound of Formula I. This chemistry is illustrated in Route 2.

Route 2

In an alternative embodiment, Structure 8 is deprotected to generate an amine which is Structure 9. Structure 9 is then coupled to generate an amide which is Structure 6. Structure 6 is then deprotected to generate a carboxylic acid which is Structure 7. Structure 7 is then coupled to form the amide which falls within Formula I. The chemistry is illustrated in Route 3.

Route 3

In an alternate embodiment, a heteroaryl or aryl moiety, 4-1, is coupled to a central core to generate 4-2. The protected acid, 4-2 is deblocked to form the carboxylic acid, 4-3. The carboxylic acid is then coupled to form an amide (L-B) which is 4-4. The heteroaryl or aryl moiety, A′, can then be further derivitized to add substitutents at the X¹¹, X¹², X¹³ and X¹⁴ positions to generate compounds of Formula I. This chemistry is illustrated in Route 4.

Route 4

In an alternate embodiment, Structure 5-1 is coupled to an acid, Structure 5-2, to generate Structure 5-3. The carboxylic acid, Structure 5-3, is deblocked to generate a carboxylic acid which is Structure 5-4. Carboxylic acid Structure 5-4 is coupled to an amine to form the product amide (L-B) which is a compound within Formula I. This chemistry is illustrated in Route 5.

Route 5

In an alternate embodiment, the protected indole, Structure 6-1, is acylated to generate Structure 6-2. Structure 6-2 is treated with the activated ester, Structure 6-3 to generate Structure 6-4. Structure 6-4 is deprotected to generated Structure 6-5. Structure 6-5 is deprotected to generate the carboxylic acid 6-6. Structure 6-6 is coupled to Structure 3 from Route 1 to generate Structure 6-7. The alcohol is converted to a leaving group, LG; see, Structure 6-8. Structure 6-8 is treated with a phosphite, an organometallic reagent, a base and an organic solvent to generate a compound within Formula I. In some embodiments, the organometallic reagent is tetrakis(triphenylphosphine)palladium(0). In some embodiments, the base is triethylamine. In some embodiments, the organic solvent is tetrahydrofuran. The chemistry is illustrated in Route 6.

Route 6

In an alternate embodiment, the protected indole, Structure 7-1, is acylated to generate Structure 7-2. Structure 7-2 is treated with the activated ester, Structure 7-3, to generate Structure 7-4. Structure 7-4 is deprotected to generated Structure 7-5. Structure 7-5 is deprotected to generate the carboxylic acid 7-6. Structure 7-6 is coupled to Structure 3 from Route 1 to generate Structure 7-7. The alcohol is converted to a leaving group, LG; see, Structure 7-8. Structure 7-8 is treated with a phosphite, an organometallic reagent, a base and an organic solvent to generate a compound within Formula I. In some embodiments, the organometallic reagent is tetrakis(triphenylphosphine)palladium(0). In some embodiments, the base is triethylamine. In some embodiments, the organic solvent is tetrahydrofuran. This chemistry is illustrated in Route 7 below.

Route 7

In an alternate embodiment, a protected indazole, Structure 8-1, is acylated to generate Structure 8-2. Structure 8-2 is treated with the activated ester, Structure 8-3, to generate Structure 8-4. Structure 8-4 is deprotected to generated Structure 8-5. Structure 8-5 is deprotected to generate the carboxylic acid 8-6. Structure 8-6 is coupled to Structure 3 from Route 1 to generate Structure 8-7. The alcohol in Structure 8-7 is converted to a leaving group; see, Structure 8-8. Structure 8-8 is treated with a phosphite, an organometallic reagent, a base and an organic solvent to generate a compound within Formula I. In some embodiments, the organometallic reagent is tetrakis(triphenylphosphine)palladium(0). In some embodiments, the base is triethylamine. In some embodiments, the organic solvent is tetrahydrofuran. In some embodiments, the phosphite is diethyl phosphite. The chemistry is illustrated in Route 8 below.

Route 8

In an alternate embodiment, a protected indazole, Structure 9-1, is acylated to generate Structure 9-2. Structure 9-2 is treated with the activated ester, Structure 9-3, to generate Structure 9-4. Structure 9-4 is deprotected to generated Structure 9-5. Structure 9-5 is deprotected to generate the carboxylic acid 9-6. Structure 9-6 is coupled to Structure 3 from Route 1 to generate Structure 9-7. The alcohol is converted to a leaving group; see, Structure 9-8. Structure 9-8 is treated with a phosphite, an organometallic reagent, a base and an organic solvent to generate a compound within Formula I. In some embodiments, the phosphite is diethyl phosphite. In some embodiments, the organometallic reagent is tetrakis(triphenylphosphine)palladium(0). In some embodiments, the base is triethylamine. In some embodiments, the organic solvent is tetrahydrofuran. The chemistry is illustrated in Route 9 below.

Route 9

In an alternate embodiment, a diethyl phosphonate from Route 9 is treated with TMSBr to generate a monoester, see, Structure 1, Route 10. In an alternate embodiment, a diethylphosphonate is treated with TMSBr to generate the phosphonic acid; Structure 2. The phosphonic acid Structure 2 can be used to generate phosphonate esters of the present invention, wherein the phosphonate is —P(O)R²⁰R²⁰. For example, Structure 2 can be treated with X—C(R^(20a))OC(O)R^(20b) to form a mixture of mono and diesters that can be separated by chromatography, wherein X is a leaving group. In one embodiment the leaving group is a halide. This chemistry is illustrated in Route 10.

Route 10

In an alternate embodiment, a diethyl phosphonate from Route 8 is treated with TMSBr to generate a monoester, see, Structure 1, Route 11. In an alternate embodiment, a diethyl phosphonate is treated with TMSBr to generate the phosphonic acid; Structure 2. The phosphonic acid Structure 2 can be used to generate phosphonate esters of the present invention, wherein the phosphonate is —P(O)R²⁰R²⁰. For example, Structure 2 can be treated with X—C(R^(20a))OC(O)R^(20b) to form a mixture of mono and diesters that can be separated by chromatography, wherein X is a leaving group. In one embodiment the leaving group is a halide. This chemistry is illustrated in Route 11.

Route 11

In an alternate embodiment, Structure 12-1 is coupled to an amine to generate an amide (L-B), which is Structure 12-2. Structure 12-2, is coupled to an amine to generate compounds within Formula I. This chemistry is illustrated in Route 12.

Route 12

Example 2. Examples of Central Synthons

Z^(A) is halogen.

In one embodiment, deuterated L-proline synthons are disclosed. Deuterated synthons include, but are not limited to, for example, the following compounds:

Structure A can be treated with deuterium oxide to generate Structure B. See, Barraclough, P. et al. Tetrahedron Lett. 2005, 46, 4653-4655; Barraclough, P. et al. Org. Biomol. Chem. 2006, 4, 1483-1491 and WO 2014/037480 (p. 103). Structure B can be reduced to generate Structure C. See, Barraclough, P. et al. Tetrahedron Lett. 2005, 46, 4653-4655; Barraclough, P. et al. Org. Biomol. Chem. 2006, 4, 1483-1491. Structure C can be treated with Mitsunobu reaction conditions to generate Structure D. Structure B can be treated with DAST to generate Structure E. See, WO 2014/037480. Structure A can be treated with sodium borodeuteride to generate Structure F. See, Dormoy, J. -R.; Castro, B. Synthesis 1986, 81-82. Compound F can be used to generate Structure K. See, Dormoy, J. -R.; Castro, B. Synthesis 1986, 81-82. Structure B can be treated with a deuterated reducing agent, for example sodium borodeuteride to generate Structure G. Structure G can be treated with DAST to generate Structure H. Structure F can be used to generate Structure K. See, Dormoy, J. -R.; Castro, B. Synthesis 1986, 81-82. Structure G can be used to generate Structure I. Structure J can be prepared according to Hruby, V. J. et al. J. Am. Chem. Soc. 1979, 101, 202-212. Structures A-J can be used to prepare compounds of Formula I.

Example 3. Preparation of Central-L-B Synthons

Routes 1a, 1b and 1c.

In Route 1a, 5-azaspiro[2.4]heptane-4,5-dicarboxylic acid, 5-(1,1-dimethylethyl) ester, (4S)-, CAS 209269-08-9, can be prepared as described in Tandon, M. et al. Bioorg. Med. Chem. Lett. 1998, 8, 1139-1144. In Step 2, the protected azaspiro[2.4]heptane is coupled to an amine in the presence of an organic solvent, a base and a coupling reagent to generate an amide bond; the L-B moiety. In one embodiment, the amine is (3-chloro-2-fluorophenyl) methanamine. In one embodiment, the organic solvent is DMF. In one embodiment, the base is diisopropylethylamine. In one embodiment, the coupling reagent is HATU. In Step 3, the protecting group is removed. In one embodiment, the starting material is reacted with an acid in the presence of an organic solvent. In one embodiment, the acid is 4N hydrochloric acid. In one embodiment, the organic solvent is dioxane.

In Route 1b, (4S) 4-oxazolidinecarboxylic acid, hydrochloride is treated with an amine protecting reagent. In one embodiment, the amine protecting reagent is di-tert-butyl dicarbonate. In another embodiment, 3,4-oxazolidinedicarboxylic acid, 3-(1,1-dimethylethyl) ester, (4S)-, is commercially available from JPM2 Pharmaceuticals. In one embodiment the reaction is carried out in an organic solvent in the presence of a base. In one embodiment, the organic solvent is acetonitrile. In one embodiment, the base is 4-dimentylaminopyridine (DMAP). In Step 2, the protected 4-oxazolidinecarboxylic acid is coupled to an amine in the presence of an organic solvent, a base and a coupling reagent to generate an amide bond; the L-B moiety. In one embodiment, the amine is (3-chloro-2-fluorophenyl) methanamine. In one embodiment, the organic solvent is DMF. In one embodiment, the base is diisopropylethylamine. In one embodiment, the coupling reagent is HATU. In Step 3, the protecting group is removed. In one embodiment, the starting material is reacted with an acid in the presence of an organic solvent. In one embodiment, the acid is 4N hydrochloric acid. In one embodiment, the organic solvent is dioxane.

In Route 1c, (S)-5-(tert-Butoxycarbonyl)-5-azaspiro[2.4]heptane-6-caboxylic acid, CAS 1129634-44-1, is commercially available from Ark Pharm. In Step 2, the carboxylic acid is coupled to an amine in the presence of an organic solvent, a base and a coupling reagent to generate an amide bond; the L-B moiety. In one embodiment, the amine is (3-chloro-2-fluorophenyl) methanamine. In one embodiment, the organic solvent is DMF. In one embodiment, the base is diisopropylethylamine. In one embodiment, the coupling reagent is HATU. In Step 3, the protecting group is removed. In one embodiment, the starting material is reacted with an acid in the presence of an organic solvent. In one embodiment, the acid is 4N hydrochloric acid. In one embodiment, the organic solvent is dioxane.

Routes 2a, 2b, 2c, and 2d.

In Route 2a, commercially available Boc-L-proline is coupled to an amine in the presence of an organic solvent, a base and a coupling reagent to generate an amide bond; the L-B moiety. In one embodiment, the amine is (3-chloro-2-fluorophenyl) methanamine. In one embodiment, the organic solvent is DMF. In one embodiment, the base is diisopropylethylamine. In one embodiment, the coupling reagent is HATU. In Step 2, the Boc protecting group is removed. In one embodiment, the starting material is reacted with an acid in the presence of an organic solvent. In one embodiment, the acid is 4N hydrochloric acid. In one embodiment, the organic solvent is dioxane.

In Route 2b, commercially available (1R,3S,5R)-2-[(tert-butoxy)carbonyl]-2-azabicyclo[3.1.0]hexane-3-carboxylic acid, from Enamine, is coupled to an amine in the presence of an organic solvent, a base and a coupling reagent to generate an amide bond; the L-B moiety. In one embodiment, the amine is (3-chloro-2-fluorophenyl) methanamine. In one embodiment, the organic solvent is DMF. In one embodiment, the base is diisopropylethylamine. In one embodiment, the coupling reagent is HATU. In Step 2, the Boc protecting group is removed. In one embodiment, the starting material is reacted with an acid in the presence of an organic solvent. In one embodiment, the acid is 4N hydrochloric acid. In one embodiment, the organic solvent is dioxane.

In Route 2c, commercially available (2S,4R)-1-(tert-butoxycarbonyl)-4-fluoropyrrolidine-2-carboxylic acid, from Manchester Organics, is coupled to an amine in the presence of an organic solvent, a base and a coupling reagent to generate an amide bond; the L-B moiety. In one embodiment, the amine is (3-chloro-2-fluorophenyl) methanamine. In one embodiment, the organic solvent is DMF. In one embodiment, the base is diisopropylethylamine. In one embodiment, the coupling reagent is HATU. In Step 2, the Boc protecting group is removed. In one embodiment, the starting material is reacted with an acid in the presence of an organic solvent. In one embodiment, the acid is 4N hydrochloric acid. In one embodiment, the organic solvent is dioxane.

In Route 2d, commercially available (S)-1-(tert-butoxycarbonyl)indoline-2-carboxylic acid, from Chem-Impex, is coupled to an amine in the presence of an organic solvent, a base and a coupling reagent to generate an amide bond; the L-B moiety. In one embodiment, the amine is (3-chloro-2-fluorophenyl) methanamine. In one embodiment, the organic solvent is DMF. In one embodiment, the base is diisopropylethylamine. In one embodiment, the coupling reagent is HATU. In Step 2, the Boc protecting group is removed. In one embodiment, the starting material is reacted with an acid in the presence of an organic solvent. In one embodiment, the acid is 4N hydrochloric acid. In one embodiment, the organic solvent is dioxane. This chemistry is illustrated in Scheme 3.

Additional starting materials that can readily be converted to Central-L-B-Synthons include, but are not limited to: (S)-1-(tert-butoxycarbonyl)-2,3-dihydro-1H-pyrrole-2-carboxylic acid, CAS 90104-21-5, available from Ark Pharm; cyclopent-1-ene-1,2-dicarboxylic acid, CAS 3128-15-2, purchased from Ark Pharm; imidazole, 1H-imidazole-1,2-dicarboxylic acid, 1-(1,1-dimethylethyl) 2-ethyl ester, CAS 553650-00-3, commercially available from FCH Group; Boc-L-octahydroindole-2-carboxylic acid can be purchased from Chem Impex. The compound,

can be prepared according to the procedures disclosed in WO 2004/111041; (S)-Boc-5-oxopyrrolidine-2-carboxylic acid is available from the Aldrich Chemical Co.; (1S,2S,5R)-3-(tert-butoxycarbonyl)-3-azabicyclo[3.3.0]hexane-2-carboxylic acid is available from Ark Pharm; (S)-3-Boc-thiazolidine-2-carboxylic acid is available from Alfa Aesar; (2S,4R)-1-(tert-butoxycarbonyl)-4-chloropyrrolidine-2-carboxylic acid is available from Arch Bioscience; (1S,3aR,6aS)-2-(tert-butoxycarbonyl)octahydrocyclopenta[c]pyrrole-1-carboxylic acid is available from Ark Pharm; 1,2-pyrrolidinedicarboxylic acid, 3-[[(phenylmethoxy)carbonyl]amino]-, 1-(1,1-dimethylethyl) ester, (2S,3R) can be prepared as disclosed in WO 2004/007501. The Cbz group can be removed and the amino group can be alkylated to generate central core compounds of the present invention.

The compound

can be prepared as disclosed by Braun, J. V.; Heymons, Albrecht Berichte der Deutschen Chemischen Gesellschaft [Abteilung] B: Abhandlungen (1930) 63B, 502-7.

The compounds (2S,3S,4S)-4-fluoro-3-methoxy-pyrrolidine-1,2-dicarboxylic acid 1-tert-butyl ester and (2R,3R,4R)-3-fluoro-4-methoxy-pyrrolidine-1,2-dicarboxylic acid 1-tert-butyl ester can be prepared as a mixture according to WO 2012/093101 to Novartis and the regioisomers can be ultimately separated once coupled to generate the central core-L-B synthons. The compound (S)-Boc-5-oxopyrrolidine-2-carboxylic acid is available from the Aldrich Chemical Co.

Example 4. Preparation of A-C(O)-Moiety

Examples of the preparation of the A-C(O)-Moiety can be found in Example 1 and below.

In an alternate embodiment, an indole is acylated in Step 1. In Step 2, the indole is treated with an activated ester. In Step 3, a protecting group is removed. In Step 4, an ester is hydrolyzed to generate the A-C(O) moiety. This chemistry is illustrated in Scheme 1.

Example 5. Coupling of Central-L-B-Synthons to A-C(O)-Moieties

Examples of the coupling of central-L-B-synthons to A-C(O)-moieties can be found in Example 1.

Example 6. Synthesis of Phosphonates within Formula I

Examples of the synthesis of phosphonates within Formula I can be found in Scheme 2 and below.

(2S,4R)-tert-butyl 2-((3-chloro-2-fluoro-benzyl)carbamoyl)-4-fluoropyrrolidine-1-carboxylate (36)

(2S,4R)-1-(tert-butoxycarbonyl)-4-fluoropyrrolidine-2-carboxylic acid 34 (2.33 gm, 10 mmol) was dissolved in DMF (50 ml) and ^(i)Pr₂NEt (8.6 ml, 5 eq.) was added, followed by the addition of (3-chloro-2-fluorophenyl) 35 methanamine (3.18 gm 20 mmol) at 5° C. Then HATU (8 gm, 2.1 eq) was added slowly at same temperature. The reaction mixture was then stirred for 18 h at RT. After completion of the reaction monitored by HPLC, The reaction mixture was diluted with 1M citric acid solution (200 ml+NaCl solid 20 gm) and extracted with DCM (150 mL×2), the organic layer was then washed with an aqueous solution of NaHCO₃ (100 ml) and washed with water (100 ml), brine (100 ml) and dried over Na₂SO₄ and concentrated under reduced pressure. The remaining residue was purified by column chromatography (eluted with DCM/EtOAc) to give (2S,4R)-tert-butyl 2-((3-chloro-2-fluorobenzyl)carbamoyl)-4-fluoropyrrolidine-1-carboxylate 36.

(2S,4R)—N-(3-chloro-2-fluorobenzyl)-4-fluoropyrrolidine-2-carboxamide hydrochloride (38)

(2S,4R)-tert-butyl 2-((3-chloro-2-fluorobenzyl)carbamoyl)-4-fluoropyrrolidine-1-carboxylate 37 (500 mg,) was taken in 4N HCl dioxane (30 ml) and resulting reaction mixture was stirred at rt for 3 h. After completion of the reaction monitored by HPLC solvent was removed under reduced pressure. The residue, 38, was used for next reaction.

Example 7. Synthesis of diethyl (3-acetyl-1-(2-((2S,4R)-2-((3-chloro-2-fluorobenzyl)carbamoyl)-4-fluoropyrrolidin-1-yl)-2-oxoethyl)-1H-indol-6-yl)phosphonate (1)

Under an atmosphere of argon gas, trifluoromethanesulfonic anhydride (250 μL) was added dropwise to a cooled (0° C.) solution of (2S,4R)-1-(2-(3-acetyl-6-hydroxy-1H-indol-1-yl)acetyl)-N-(3-chloro-2-fluorobenzyl)-4-fluoropyrrolidine-2-carboxamide 39 (551 mg) in pyridine (10 mL). The resulting solution was stirred at 0° C. for 2.5 h, allowed to warm to rt, and concentrated under reduced pressure to afford an oil. This material was dissolved in ethyl acetate (75 mL), and the resulting solution was washed with a 1M aq. solution of citric acid (2×25 mL), and brine (25 mL). The organic layer was dried over sodium sulfate, and evaporated under reduce pressure to afford the crude product. This material was purified by flash column chromatography on silica (methanol/dichloromethane gradient, 0 to 5% v/v) to provide 3-acetyl-1-(2-((2S,4R)-2-((3-chloro-2-fluorobenzyl)carbamoyl)-4-fluoropyrrolidin-1-yl)-2-oxoethyl)-1H-indol-6-yl trifluoromethanesulfonate 40 as a solid. LC-MS (method 1): t_(R) 2.39 min, m/z found 622 ([M+H]⁺).

Under an atmosphere of argon gas, a mixture of 3-acetyl-1-(2-((2S,4R)-2-((3-chloro-2-fluorob enzyl)carbamoyl)-4-fluoropyrrolidin-1-yl)-2-oxoethyl)-1H-indol-6-yl trifluoromethanesulfonate 40 (526 mg), diethyl phosphite (1.2 mL), triethylamine (217 μL), and tetrakis(triphenylphosphine)palladium(0) (100 mg) in tetrahydrofuran (30 mL) was stirred at 100° C. in a sealed tube for 18 h. The reaction mixture was allowed to cool to room temperature and concentrated under reduced pressure. The remaining residue was purified by flash column chromatography on silica (methanol/dichloromethane gradient, 0 to 5% v/v) to afford diethyl (3-acetyl-1-(2-((2S,4R)-2-((3-chloro-2-fluorobenzyl)carbamoyl)-4-fluoropyrrolidin-1-yl)-2-oxoethyl)-1H-indol-6-yl)phosphonate 1 as a solid. LC-MS (method 1): t_(R) 1.84 min, m/z found 610 ([M+H]+). LC-MS (method 2): t_(R) 7.15 min, m/z found 610 ([M+H]+).

Example 8. Synthesis of ethyl hydrogen (3-acetyl-1-(2-((2S,4R)-2-((3-chloro-2-fluorobenzyl)carbamoyl)-4-fluoropyrrolidin-1-yl)-2-oxoethyl)-1H-indol-6-yl)phosphonate (2)

Under an atmosphere of argon gas at rt, bromotrimethylsilane (132 mg) was added to a solution of diethyl (3-acetyl-1-(2-((2S,4R)-2-((3-chloro-2-fluorobenzyl)carbamoyl)-4-fluoropyrrolidin-1-yl)-2-oxoethyl)-1H-indol-6-yl)phosphonate 1 (200 mg) in dichloromethane (5 mL) at rt. The resulting solution was stirred for 3 h and evaporated to dryness under reduced pressure. The reaction was stopped at 3 h when the majority of the product was the monoethyl phosphonate. The residue was treated with a mixture of dichloromethane and methanol (3:1 v/v, 15 mL) and evaporated under reduced pressure. This treatment was repeated once, and the remaining solid was washed with ethyl acetate (15 mL), and dried in vacuo overnight. Ethyl hydrogen (3-acetyl-1-(2-((2S,4R)-2-((3-chloro-2-fluorobenzyl)carbamoyl)-4-fluoropyrrolidin-1-yl)-2-oxoethyl)-1H-indol-6-yl)phosphonate 2 was purified by HPLC to provide 25 mg of solid. LC-MS: t_(R) 1.20 min, m/z found 582 ([M+H]⁺).

Example 9. Synthesis of (3-acetyl-1-(2-((2S,4R)-2-((3-chloro-2-fluorobenzyl)carbamoyl)-4-fluoropyrrolidin-1-yl)-2-oxoethyl)-1H-indol-6-yl)phosphonic acid (3)

Under an atmosphere of argon gas at rt, bromotrimethylsilane (233 mg) was added to a solution of diethyl (3-acetyl-1-(2-((2S,4R)-2-((3-chloro-2-fluorobenzyl)carbamoyl)-4-fluoropyrrolidin-1-yl)-2-oxoethyl)-1H-indol-6-yl)phosphonate 1 (150 mg) in dichloromethane (5 mL) at rt. The resulting solution was stirred for 18 h and evaporated to dryness under reduced pressure. The remaining residue was treated with a mixture of dichloromethane and methanol (3:1 v/v, 15 mL) and evaporated under reduced pressure. This treatment was repeated once, and the remaining solid was washed with ethyl acetate (15 mL), and dried in vacuo overnight to afford 132 mg of (3-acetyl-1-(2-((2S,4R)-2-((3-chloro-2-fluorobenzyl)carbamoyl)-4-fluoropyrrolidin-1-yl)-2-oxoethyl)-1H-indol-6-yl)phosphonic acid 3. LC-MS (method 1): t_(R) 1.06 min, m/z found 554 ([M+H]⁺). LC-MS (method 2): t_(R) 5.40 min, m/z found 554 ([M+H]+).

Example 10. Synthesis of (2S,4R)-1-(2-(3-acetyl-6-hydroxy-1H-indol-1-yl)acetyl)-N-(3-chloro-2-fluorobenzyl)-4-fluoropyrrolidine-2-carboxamide (39)

Phosphoryl chloride (103 mL, 10 equiv) was added to ice-cold N,N-dimethylacetamide (311 mL, 30 equiv) with stirring and cooling in ice. 6-Benzyloxy indole 41 (25 g, 1 equiv) was then added and the reaction mixture was stirred at rt for 12 h, then poured over ice and basified with a 4 N aqueous sodium hydroxide solution until a precipitate formed. The solid was collected by filtration, washed with water, and dried. The solid was then slurried with methanol, collected by filtration, and dried to give 1-(6-(benzyloxy)-1H-indol-3-yl)ethanone 42 (20 g, 67%).

To a mixture of 1-(6-(benzyloxy)-1H-indol-3-yl)ethanone 42 (25 g, 1 equiv) and potassium carbonate (11.6 g, 1.1 equiv) in acetonitrile (384 mL) was added tert-butyl bromoacetate (12.4 mL, 1.1 equiv) dropwise at rt. The resulting mixture was heated to reflux for 12 h, allowed to cool to rt, poured into water, and extracted with EtOAc. The combined organic extracts were concentrated under reduced pressure. The resulting solid was slurried with MTBE, collected by filtration, and dried to give tert-butyl 2-(3-acetyl-6-(benzyloxy)-1H-indol-1-yl)acetate 43 (26 g, 72%).

A mixture of tert-butyl 2-(3-acetyl-6-(benzyloxy)-1H-indol-1-yl)acetate 43 (22 g, 1 equiv), DCM/MeOH (600 mL), and Pd/C (2.2 g, 10%) was stirred at rt for 12 h under an atmosphere of H₂ (3.5 kg/cm²). The reaction mixture was filtered through a pad of Celite® and washed with DCM and MeOH. The filtrate was evaporated under reduce pressure, and the remaining crude product was slurried with DCM, collected by filtration, and dried to give tert-butyl 2-(3-acetyl-6-hydroxy-1H-indol-1-yl)acetate 44 (11.5 g, 69%).

tert-Butyl 2-(3-acetyl-6-hydroxy-1H-indol-1-yl)acetate 44 (5 g) was treated with TFA (10 mL) in DCM (30 mL) for 2 h at rt. After evaporation of the volatiles under reduced pressure, 2-(3-acetyl-6-hydroxy-1H-indol-1-yl)acetic acid 45 was obtained.

2-(3-Acetyl-6-hydroxy-1H-indol-1-yl)acetic acid 45 (2.5 g) and 38 (3.6 g) were coupled in the presence of HATU and DIEA using a procedure similar to that described for the synthesis of 38 to give (2S,4R)-1-(2-(3-acetyl-6-hydroxy-1H-indol-1-yl)acetyl)-N-(3-chloro-2-fluorobenzyl)-4-fluoropyrrolidine-2-carboxamide 39.

Example 11. Synthesis of (2S,3aR,6aR)—N-(3-chloro-2-fluorobenzyl)octahydrocyclopenta[b]pyrrole-2-carboxamide TFA salt (49)

(2S,3aR,6aR)-Octahydrocyclopenta[b]pyrrole-2-carboxylic acid 46 (0.32 g) was dissolved in THF-H₂O (1:1, 14 mL) in the presence of NaHCO₃ (0.52 g). Di-tert-butyl dicarbonate (0.95 mL) was added and the mixture was stirred at rt overnight. The reaction mixture was diluted with EtOAc and extracted with water. To the aqueous layer was added concentrated HCl to adjust the pH to 2, and then extracted with EtOAc. The combined organic extracts were dried over anhydrous Na₂SO₄ and evaporated to give (2S,3aR,6aR)-1-(tert-butoxycarbonyl)octahydrocyclopenta[b]pyrrole-2-carboxylic acid 47 as a clear oil (0.532 g).

(2S,3aR,6aR)-1-(tert-Butoxycarbonyl)octahydrocyclopenta[b]pyrrole-2-carboxylic acid 47 (2 mmol) and (3-chloro-2-fluorophenyl)methanamine (1.2 equiv) were dissolved in DMF (5 mL) and treated with HATU (1.2 equiv) followed by DIEA (1 mL). After stirring for 2 h at rt, the reaction mixture was diluted with water and extracted with EtOAc. The extract was evaporated under reduced pressure and the remaining crude material was purified by column chromatography to give (2S,3aR,6aR)-1-tert-butyl 2-(3-chloro-2-fluorobenzyl) hexahydrocyclopenta[b]pyrrole-1,2(2H)-dicarboxylate 48 as a white solid.

(2S,3aR,6aR)-1-tert-Butyl 2-(3-chloro-2-fluorobenzyl) hexahydrocyclopenta[b]pyrrole-1,2(2H)-dicarboxylate 48 (159 mg) was treated with TFA (3 mL) in DCM (3 mL) for 1 h at rt. After evaporation of the volatiles, (2S,3aR,6aR)—N-(3-chloro-2-fluorobenzyl)octahydrocyclopenta[b]pyrrole-2-carboxamide TFA salt 49 was obtained.

Example 12. Synthesis of 2-(3-acetyl-6-(diethoxyphosphoryl)-1H-indol-1-yl)acetic acid (54)

1-(6-Bromo-1H-indol-3-yl)ethanone 51 was prepared from 6-bromoindole 50 according to the procedure of MacKay et al. (MacKay, J. A.; Bishop, R.; Rawal, V. H. Org. Lett. 2005, 7, 3421-3424.)

A mixture of 3.9 g (16.4 mmol) of 1-(6-bromo-1H-indol-3-yl)ethanone 51, 2.63 mL (18.02 mmol) of tert-butyl bromoacetate and 2.50 g (18.02 mmol) potassium carbonate in anhydrous acetonitrile (80 mL) was refluxed for 5 h. The reaction mixture was then cooled to rt and the solvent was removed under reduced pressure. The residue was taken in 1:1 mixture of DCM and water (100 mL: 100 mL). The two layers were separated and the organic layer was washed with water (2×100 mL). Finally, the organic layer was dried (Na₂SO₄) and concentrated. The resulting residue was stirred with 50 mL of heptane for 30 min, cooled in an ice bath and filtered, washing the solid with cold heptane (10 mL). This cream colored solid was dried under high vacuum to give 5.6 g of tert-butyl 2-(3-acetyl-6-bromo-1H-indol-1-yl)acetate 52.

tert-Butyl 2-(3-acetyl-6-bromo-1H-indol-1-yl)acetate 52 was converted to tert-Butyl 2-(3-acetyl-6-(diethoxyphosphoryl)-1H-indol-1-yl)acetate 53 as described in Scheme 11.

tert-Butyl 2-(3-acetyl-6-(diethoxyphosphoryl)-1H-indol-1-yl)acetate 53 (67 mg) was treated with 4 N HCl in dioxane (5 mL) at rt overnight. The volatiles were removed under reduced pressure to give 2-(3-acetyl-6-(diethoxyphosphoryl)-1H-indol-1-yl)acetic acid 54.

Example 19. Synthesis of (3-acetyl-1-(2-((2S,3aR,6aR)-2-((3-chloro-2-fluorobenzyl)carbamoyl)hexahydrocyclopenta[b]pyrrol-1(2H)-yl)-2-oxoethyl)-1H-indol-6-yl)phosphonic acid (7)

To a mixture of 2-(3-acetyl-6-(diethoxyphosphoryl)-1H-indol-1-yl)acetic acid 54 (0.164 mmol) and (2S,3aR,6aR)—N-(3-chloro-2-fluorobenzyl)octahydrocyclopenta[b]pyrrole-2-carboxamide TFA salt 49 (1.2 equiv) in DMF (2 mL), was added HATU (1.2 equiv) followed by DIEA (3.0 equiv). After stirring at rt for 1 h, the volatiles were removed under reduced pressure and the remaining residue was purified by column chromatography (7% MeOH in DCM as eluent) to give diethyl (3-acetyl-1-(2-((2S,3aR,6aR)-2-((3-chloro-2-fluorobenzyl)carbamoyl)hexahydrocyclopenta[b]pyrrol-1 (2H)-yl)-2-oxoethyl)-1H-indol-6-yl)phosphonate 5 (43 mg). LC-MS (method A): t_(R) 2.13 min, m/z found 632 ([M+H]⁺).

Diethyl (3-Acetyl-1-(2-((2S,3aR,6aR)-2-((3-chloro-2-fluorobenzyl)carbamoyl)hexahydrocyclopenta[b]pyrrol-1 (2H)-yl)-2-oxoethyl)-1H-indol-6-yl)phosphonate 5 was treated with TMSBr (7 equiv) in DCM at rt overnight. After evaporation under reduced pressure, the remaining residue was treated with a mixture of dichloromethane and methanol (3:1 v/v, 15 mL) and evaporated under reduced pressure. This treatment was repeated once, and the remaining solid was washed with ethyl acetate (15 mL), and dried in vacuo overnight to give (3-acetyl-1-(2-((2S,3aR,6aR)-2-((3-chloro-2-fluorobenzyl)carbamoyl)hexahydrocyclopenta[b]pyrrol-1 (2H)-yl)-2-oxoethyl)-1H-indol-6-yl)phosphonic acid 7 (17 mg). ¹H NMR (400 MHz, methanol-d₄): (major rotamer) δ 1.49-1.53 (m, 1H), 1.58-1.66 (m, 1H), 1.70-1.80 (m, 1H), 1.98-2.05 (m, 1H), 2.17-2.23 (m, 1H), 2.35-2.45 (m, 2H), 2.88-2.94 (m, 1H), 4.31-4.33 (m, 2H), 4.45-4.47 (m, 1H), 4.51-4.58 (m, 1H), 5.08 (d, J=18 Hz, 1H), 5.33 (d, J=17 Hz, 1H), 6.95 (t, J=8 Hz, 1H), 7.15-7.27 (m, 2H), 7.56 (t, J=8 Hz, 1H), 7.78 (d, J=15 Hz, 1H), 8.25 (s, 1H), 8.26-8.28 (m, 1H). ¹⁹F NMR (376 MHz, methanol-d₄): (major rotamer) δ−123.3 (s). ³¹P NMR (162 MHz, methanol-d₄): (major rotamer) δ 17.6 (s). LC-MS (method A): t_(R) 1.44 min, m/z found 576 ([M+H]⁺).

Example 14. Synthesis of (3-carbamoyl-1-(2-((2S,4R)-2-((3-chloro-2-fluorobenzyl)carbamoyl)-4-fluoropyrrolidin-1-yl)-2-oxoethyl)-1H-indazol-6-yl)phosphonic acid (18)

To a solution of ethyl 6-bromo-1H-indazole-3-carboxylate 66 (2.69 g, 10 mmol) and tert-butyl 2-bromoacetate (2.73 g, 2.1 mL, 14.0 mmol) in CH₃CN (70 mL), was added solid potassium carbonate (3.18 g, 23 mmol). The mixture was heated at reflux in an oil bath overnight under an atmosphere of argon gas. The reaction mixture was cooled to rt and filtered through a pad of Celite®. The solid cake was washed with CH₃CN (20 mL), and the combined solution was concentrated under reduced pressure. The residue was purified by flash column chromatography on silica to afford ethyl 6-bromo-1-(2-(tert-butoxy)-2-oxoethyl)-1H-indazole-3-carboxylate 56 (3.3 g). ¹H NMR (400 MHz, CDCl₃): δ 1.45 (s, 9H), 1.48 (t, J=7.2 Hz, 3H), 4.52 (q, J=7.2 Hz, 2H), 5.11 (s, 2H), 7.42 (d, J=8.8 Hz, 1H), 7.56 (s, 1H), 8.08 (d, J=8.8 Hz, 1H).

Under an atmosphere of argon gas, a mixture of ethyl 6-bromo-1-(2-(tert-butoxy)-2-oxoethyl)-1H-indazole-3-carboxylate 56 (3.3 g, 8.6 mmol), diethyl phosphite (1.45 mL, 11.2 mmol), triethylamine (1.78 mL, 12.9 mmol), and tetrakis(triphenylphosphine)palladium(0) (0.09 mmol) in tetrahydrofuran (100 mL) was heated at reflux overnight. The reaction mixture was allowed to cool to rt and concentrated under reduced pressure. The remaining residue was purified by flash column chromatography on silica to afford ethyl 1-(2-(tert-butoxy)-2-oxoethyl)-6-(diethoxyphosphoryl)-1H-indazole-3-carboxylate 57 as an oil (3.98 g). ¹H NMR (400 MHz, CDCl₃): δ 1.33 (t, J=7.2 Hz, 6H), 1.45 (s, 9H), 1.49 (t, J=7.2 Hz, 3H), 4.13-4.21 (m, 4H), 4.53 (q, J=7.2 Hz, 2H), 5.22 (s, 2H), 7.65 (dd, J=0.8, 8.4 Hz, 1H), 8.02 (d, J=15.2 Hz, 1H), 8.33 (dd, J=2.8, 8.4 Hz, 1H). ³¹P NMR (162 MHz, DMSO-d₆): δ 18.36.

Ethyl 1-(2-(tert-butoxy)-2-oxoethyl)-6-(diethoxyphosphoryl)-1H-indazole-3-carboxylate 57 (3.98 g, 9.03 mmol) was dissolved in 20 mL of DCM and treated with 5 mL TFA. The mixture was stirred overnight at rt. The volatiles were removed under reduced pressure and the residue was co-evaporated with toluene (10 mL) twice. The dried residue 58 was used directly in the next synthetic step.

2-(6-(Diethoxyphosphoryl)-3-(ethoxycarbonyl)-1H-indazol-1-yl)acetic acid 58 (2.18 g, 4.37 mmol) was mixed with (2S,4R)—N-(3-chloro-2-fluorobenzyl)-4-fluoropyrrolidine-2-carboxamide hydrochloride 38 (1.36 g, 4.37 mmol), HATU (1.91 g, 5.02 mmol), and DMF (25 mL). To the resulting solution was added DIEA (4.5 mmol, 0.78 mL) dropwise. The mixture was stirred for 1 h at rt and the volatiles were removed under reduced pressure. The remaining residue was diluted with 10% aqueous sodium carbonate (20 mL) and water (50 mL), and then extracted with ethyl acetate (3×50 mL). The combined organic extracts were washed with water and brine, and then dried over MgSO₄. The solution was filtered and the solvent was removed under reduced pressure. The residue was purified by column chromatography to afford ethyl 1-(2-((2S,4R)-2-((3-chloro-2-fluorob enzyl)carbamoyl)-4-fluoropyrrolidin-1-yl)-2-oxoethyl)-6-(diethoxyphosphoryl)-1H-indazole-3-carboxylate 11. ¹H NMR (400 MHz, DMSO-d₆): (major rotamer) δ 1.24 (t, J=7.2 Hz, 6H), 1.39 (t, J=7.2 Hz, 3H), 2.04-2.18 (m, 1H), 2.46-2.57 (m, 1H), 3.92-4.02 (m, 1H), 4.04-4.08 (m, 4H), 4.11-4.36 (m, 2H), 4.38-4.48 (m, 4H), 5.53 (d, J=52.8 Hz, 1H), 5.64-5.98 (m, 2H), 7.0 (t, J=7.6 Hz, 1H), 7.21 (t, J=7.2 Hz, 1H), 7.41 (t, J=7.6 Hz, 1H), 7.59-7.64 (m, 1H), 8.20-8.27 (m, 2H), 8.61 (t, J=6.0, 1H). ³¹P NMR (162 MHz, DMSO-d₆): (major rotamer) δ 18.07. ¹⁹F NMR (376 MHz, DMSO-d₆): (major rotamer) δ−121.83, −176.17. LC (method A): t_(R)=2.15 min. LC/MS (EI) m/z: [M+H]⁺ 641.

Ethyl 1-(2-((2S,4R)-2-((3-chloro-2-fluorobenzyl)carbamoyl)-4-fluoropyrrolidin-1-yl)-2-oxoethyl)-6-(diethoxyphosphoryl)-1H-indazole-3-carboxylate 11 (692 mg, 1.08 mmol) was dissolved in co-solvent MeOH-THF-H₂O (3 mL-3 mL-3 mL) and then mixed with LiOH (42 mg, 1.75 mmol). The reaction mixture was stirred overnight at rt. The volatiles were removed under reduced pressure and the residue was acidified with 10% aqueous citric acid (10 mL). The white solid was collected by filtration, washed with water, and dried in vacuo to afford 1-(2-((2S,4R)-2-((3-chloro-2-fluorobenzyl)carbamoyl)-4-fluoropyrrolidin-1-yl)-2-oxoethyl)-6-(diethoxyphosphoryl)-1H-indazole-3-carboxylic acid 12. ¹H NMR (400 MHz, DMSO-d₆): (maj or rotamer) δ 1.23 (t, J=7.2 Hz, 6H), 2.04-2.20 (m, 1H), 2.46-2.57 (m, 1H), 3.87-4.02 (m, 1H), 3.98-4.08 (m, 4H), 4.17-4.38 (m, 2H), 4.40-4.45 (m, 2H), 5.53 (d, J=52.8 Hz, 1H), 5.64-5.98 (m, 2H), 7.01 (t, J=7.6 Hz, 1H), 7.21 (t, J=7.2 Hz, 1H), 7.41 (t, J=7.6 Hz, 1H), 7.59-7.64 (m, 1H), 8.21-8.27 (m, 2H), 8.61 (t, J=6.0, 1H). ³¹P NMR (162 MHz, DMSO-d₆): (major rotamer) δ 18.27. ¹⁹F NMR (376 MHz, DMSO-d₆): (major rotamer) δ−121.83, −176.18. LC (method A): t_(R)=1.65 min. LC/MS (EI) m/z: [M+H]⁺ 613.

1-(2-((2S,4R)-2-((3-Chloro-2-fluorobenzyl)carbamoyl)-4-fluoropyrrolidin-1-yl)-2-oxoethyl)-6-(diethoxyphosphoryl)-1H-indazole-3-carboxylic acid 12 (584 mg, 0.95 mmol) was mixed with NH₄Cl (153 mg, 2.85 mmol) in 5 mL DMF. To this solution was added HATU (1.42 mmol), followed by dropwise addition of DIEA (3 mL). The mixture was stirred for 3 h at rt and the volatiles were removed under reduced presssure. The residue was diluted with 10% aqueous sodium carbonate (15 mL) and water (15 mL), and then extracted with ethyl acetate (3×25 mL). The combined organic extracts were washed successively with water and brine, dried over MgSO₄, and concentrated under reduced pressure. The remaining residue was purified by column chromatography to afford diethyl (3-carbamoyl-1-(2-((2S,4R)-2-((3-chloro-2-fluorobenzyl)carbamoyl)-4-fluoropyrrolidin-1-yl)-2-oxoethyl)-1H-indazol-6-yl)phosphonate 17 (547 mg). ¹H NMR (400 MHz, DMSO-d₆): (major rotamer) δ 1.23 (t, J=7.2 Hz, 6H), 2.02-2.18 (m, 1H), 2.46-2.55 (m, 1H), 3.88-4.02 (m, 1H), 3.98-4.08 (m, 4H), 4.17-4.45 (m, 4H), 5.55 (d, J=52.8 Hz, 1H), 5.64-5.84 (m, 2H), 7.0 (t, J=7.6 Hz, 1H), 7.21 (t, J=7.2 Hz, 1H), 7.41 (t, J=7.6 Hz, 1H), 7.48-7.56 (m, 2H), 7.77 (s, 1H), 8.15 (d, J=15.6 Hz, 1H), 8.33-8.36 (m, 1H), 8.64 (t, J=6.0 Hz, 1H). ³¹P NMR (162 MHz, DMSO-d₆): (major rotamer) δ 18.48. ¹⁹F NMR (376 MHz, DMSO-d₆): (major rotamer) δ−121.80, −176.12. LC (method A): t_(R)=1.59 min. LC/MS (EI) m/z: [M+H]⁺ 612.

To a mixture of diethyl (3-carbamoyl-1-(2-((2S,4R)-2-((3-chloro-2-fluorobenzyl)carbamoyl)-4-fluoropyrrolidin-1-yl)-2-oxoethyl)-1H-indazol-6-yl)phosphonate 17 (230 mg, 0.37 mmol) in dichloromethane (30 mL) was added bromotrimethylsilane (0.8 mL) under an atmosphere of argon gas at rt. The resulting solution was stirred overnight, and evaporated to dryness under reduced pressure. The remaining residue was purified by column chromatography (eluted with DCM 10 min, gradient 0-30% MeOH containing 5% AcOH 20 min) and co-evaporated with toluene (20 mL) twice. The residue was rinsed with water, dissolved in 15 mL of CH₃CN—H₂O (3:1), and lyophilized to afford 18 (58 mg) as a powder. ¹H NMR (400 MHz, DMSO-d₆): (major rotamer) δ 1.92-2.09 (m, 1H), 2.36-2.47 (m, 1H), 3.20 (br, 2H), 3.80-3.90 (m, 1H), 4.11-4.43 (m, 4H), 5.36-5.73 (m, 3H), 6.99 (t, J=8.0 Hz, 1H), 7.16 (t, J=6.4 Hz, 1H), 7.32-7.36 (m, 2H), 7.46-7.51 (m, 1H), 7.64 (s, 1H), 8.98 (d, J=14.8 Hz, 1H), 8.17 (dd, J=2.8, 8.0 Hz, 1H), 8.57 (t, J=5.6 Hz, 1H), 11.20 (br, 2H). ³¹P NMR (162 MHz, DMSO-d₆): (major rotamer) δ 12.65. ¹⁹F NMR (376 MHz, DMSO-d₆): (major rotamer) δ−121.69, −176.06. LC (method A): t_(R)=0.70 min. LC/MS (EI) m/z: [M+H]⁺ 556.

Example 15. Synthesis of (((3-acetyl-1-(2-((2S,4R)-2-((3-chloro-2-fluorobenzyl)carbamoyl)-4-fluoropyrrolidin-1-yl)-2-oxoethyl)-1H-indol-6-yl)phosphoryl)bis(oxy))bis(methylene)bis(2,2-dimethylpropanoate) (26) and (((3-acetyl-1-(2-((2S,4R)-2-((3-chloro-2-fluorobenzyl)carbamoyl)-4-fluoropyrrolidin-1-yl)-2-oxoethyl)-1H-indol-6-yl)(hydroxy)phosphoryl)oxy)methyl pivalate (28)

A mixture of (3-acetyl-1-(2-((2S,4R)-2-((3-chloro-2-fluorobenzyl)carbamoyl)-4-fluoropyrrolidin-1-yl)-2-oxoethyl)-1H-indol-6-yl)phosphonic acid 3 (128 mg, 0.23 mmol), chloromethyl pivalate (209 mg, 1.4 mmol, 6.0 equiv), and TEA (143 mg, 0.2 mL, 6.0 equiv) in DMF (2.5 mL) was heated in a 55° C. oil bath overnight. Additional chloromethyl pivalate (209 mg, 1.4 mmol, 6.0 equiv) and TEA (143 mg, 0.2 mL, 6.0 equiv) were added and the reaction mixture was stirred at 55° C. for 24 h. The mixture was cooled to rt and the volatiles were removed under reduced pressure. The remaining residue was purified by column chromatography (eluted with DCM/MeOH) to give 26 (89.3 mg) and 28 (18.9 mg). 26: ¹H NMR (400 MHz, DMSO-d₆): (major rotamer) δ 1.03 (s, 18H), 2.05-2.20 (m, 1H), 2.46 (s, 3H), 2.50-2.60 (m, 1H), 3.81-3.98 (m, 1H), 4.12-4.47 (m, 4H), 5.29-5.51 (m, 2H), 5.60-5.63 (m, 5H), 7.0 (t, J=8.0 Hz, 1H), 7.24 (t, J=7.2 Hz, 1H), 7.42 (t, J=7.2 Hz, 1H), 7.47-7.52 (m, 1H), 8.01 (d, J=15.6 Hz, 1H), 8.32-8.35 (m, 1H), 8.43 (s, 1H), 8.62 (t, J=6.0 Hz, 1H). ³¹P NMR (162 MHz, DMSO-d₆): (major rotamer) δ 19.97. ¹⁹F NMR (376 MHz, DMSO-d₆): (major rotamer) δ−121.77, −176.00. LC (method A): t_(R)=2.41 min. LC/MS (EI) m/z: [M+H]⁺ 782. 28: ¹H NMR (400 MHz, DMSO-d₆): (major rotamer) δ 0.89 (s, 9H), 1.97-2.11 (m, 1H), 2.37 (s, 3H), 2.41-2.44 (m, 1H), 3.78-3.82 (m, 1H), 3.87-3.91 (m, 1H), 4.07-4.65 (m, 3H), 5.19-5.42 (m, 2H), 5.42-5.51 (m, 3H), 6.96 (t, J=7.6 Hz, 1H), 7.17 (t, J=6.8 Hz, 1H), 7.35 (t, J=7.6 Hz, 1H), 7.42-7.47 (m, 1H), 7.87 (d, J=14.8 Hz, 1H), 8.20-8.23 (m, 1H), 8.29 (s, 1H), 8.54 (t, J=5.6 Hz). ³¹P NMR (162 MHz, DMSO-d₆): (major rotamer) δ 16.52. ¹⁹F NMR (376 MHz, DMSO-d₆): (major rotamer) δ−121.24, −176.00. LC (method A): t_(R)=1.14 min. LC/MS (EI) m/z: [M+H]⁺ 668.

Example 22. Synthesis of (3-acetyl-1-(2-((2S,4R)-2-((3-chloro-2-fluorobenzyl)carbamoyl)-4-fluoropyrrolidin-1-yl)-2-oxoethyl)-5-fluoro-1H-indol-6-yl)phosphonic acid (31)

tert-Butyl 2-(3-acetyl-6-bromo-5-fluoro-1H-indol-1-yl)acetate 61 (1.28 g), which was prepared from 6-bromo-5-fluoro-1H-indole 59 (1 g) using procedures analogous to those described for the synthesis of tert-butyl 2-(3-acetyl-6-bromo-1H-indol-1-yl)acetate leading to 54, was treated with 4 N HCl in 1,4-dioxane (20 mL) at rt for 48 h. The volatiles were removed under reduced pressure to give 2-(3-acetyl-6-bromo-5-fluoro-1H-indol-1-yl)acetic acid 62 that was used directly in the next synthetic step.

A mixture of 2-(3-acetyl-6-bromo-5-fluoro-1H-indol-1-yl)acetic acid 62 and 38 (1.07 g) in DMF (30 mL) was treated with HATU (2.63 g) followed by DIEA (2.83 mL) at rt. After stirring overnight at rt, the reaction mixture was poured into 10% aqueous NaCl (300 mL). The resulting precipitate was collected by filtration and purified by column chromatography using MeOH in DCM as eluent to afford (2S,4R)-1-(2-(3-acetyl-6-bromo-5-fluoro-1H-indol-1-yl)acetyl)-N-(3-chloro-2-fluorobenzyl)-4-fluoropyrrolidine-2-carboxamide 63.

A mixture of (2S,4R)-1-(2-(3-acetyl-6-bromo-5-fluoro-1H-indol-1-yl)acetyl)-N-(3-chloro-2-fluorobenzyl)-4-fluoropyrrolidine-2-carboxamide 63 (0.52 g), TEA (2 equiv), and diethyl phosphite (10 equiv) in DMF (10 mL) was sparged with argon gas for 10 min. Tetrakis(triphenylphosphine)palladium(0) (115 mg) was added and the mixture was stirred at 100° C. under an atmosphere of argon gas overnight. The solvent was removed under reduced pressure and the residue was purified by column chromatography using MeOH in DCM as eluent to give diethyl (3-acetyl-1-(2-((2S,4R)-2-((3-chloro-2-fluorobenzyl)carbamoyl)-4-fluoropyrrolidin-1-yl)-2-oxoethyl)-5-fluoro-1H-indol-6-yl)phosphonate (30).

Diethyl (3-acetyl-1-(2-((2 S,4R)-2-((3-chloro-2-fluorobenzyl)carbamoyl)-4-fluoropyrrolidin-1-yl)-2-oxoethyl)-5-fluoro-1H-indol-6-yl)phosphonate 30 (100 mg) in DCM (1 mL) was treated with TMSBr (0.5 mL) at rt overnight. After the solvent was removed under reduced pressure, the residue was co-evaporated with 20% MeOH in DCM (20 mL) and washed with EtOAc to give 31 (60 mg). ¹H NMR (400 MHz, DMSO-d₆): (major rotamer) δ 2.01-2.18 (m, 1H), 2.42 (s, 3H), 2.38-2.49 (m, 1H), 3.84-4.01 (m, 2H), 4.14-4.45 (m, 4H), 5.26 (d, J=17.1 Hz, 1H), 5.50 (d, J=52.8 Hz, 1H), 5.51 (d, J=17.2 Hz, 1H), 7.06 (t, J=8 Hz, 1H), 7.24 (t, J=8 Hz, 1H), 7.41 (t, J=8 Hz, 1H), 7.83-7.88 (m, 2H), 8.37 (s, 1H), 8.62 (t, J=5.9 Hz, 1H). ¹⁹F NMR (376 MHz, DMSO-d₆): (major rotamer) δ−177.0 (s, 1F), −121.7 (s, 1F), −114.5 (s, 1F). ³¹P NMR (162 MHz, DMSO-d₆): (major rotamer) δ 8.24 (s). LC-MS (method A): t_(R) 0.93 min, m/z found 572 ([M+H]⁺).

Example 17. Synthesis (1-(2-((2S,4R)-2-((3-chloro-2-fluorobenzyl)carbamoyl)-4-fluoropyrrolidin-1-yl)-2-oxoethyl)-3-(2,2,2-trifluoroacetyl)-1H-indol-6-yl)phosphonic acid (32)

6-Bromoindole 50 (1.0 g) was dissolved in DMF (10 mL) and cooled in an ice bath. Trifluoroacetic anhydride (0.85 mL) was added to this ice-cold solution dropwise and stirred for 2.5 h at this temperature. The reaction mixture was then quenched by the addition of 50 mL of water. The precipitate was collected by filtration, washed with water, dissolved in EtOAc, and the solution was washed with a saturated aqueous solution of NaHCO₃. The organic layer separated, dried (Na₂SO₄), and concentrated to give 1-(6-bromo-1H-indol-3-yl)-2,2,2-trifluoroethanone 64 (1.5 g) as an orange solid, which was used directly in the next synthetic step.

A mixture of 1-(6-bromo-1H-indol-3-yl)-2,2,2-trifluoroethanone 64 (1.45 g), tert-butyl bromoacetate (0.8 mL), and potassium carbonate (0.752 g) in anhydrous acetonitrile (45 mL) was refluxed for 5 h. The reaction mixture was then cooled to rt and the solvent was removed under reduced pressure. The residue was taken in a 1:1 mixture of DCM and water. The two layers were separated and the organic layer was washed with water. Finally, the organic layer was dried (Na₂SO₄) and concentrated. The resulting residue was stirred with 15 mL of heptane for 30 min, cooled in an ice bath and filtered, washing the solid with cold heptane (10 mL). The solid was dried under high vacuum to give tert-butyl 2-(6-bromo-3-(2,2,2-trifluoroacetyl)-1H-indol-1-yl)acetate 65 (1.6 g).

tert-Butyl 2-(6-bromo-3-(2,2,2-trifluoroacetyl)-1H-indol-1-yl)acetate 66 (1.5 g) was stirred in 4.0 N HCl in dioxane (15 mL) overnight. The solvent was removed under reduced pressure and the residue was dissolved in DMF (15 mL). Compound 38 (1.2 g) was added, followed by of DIEA (3.2 mL). This mixture was cooled in an ice bath and HATU (1.7 g) was added. The cooling bath was then removed and the reaction mixture was stirred at rt for 1 h. The reaction mixture was then poured into water (150 mL) and the resulting solid was collected by filtration, washed with water, and dried under high vacuum to give (2S,4R)-1-(2-(6-bromo-3-(2,2,2-trifluoroacetyl)-1H-indol-1-yl)acetyl)-N-(3-chloro-2-fluorobenzyl)-4-fluoropyrrolidine-2-carboxamide 67 (1.9 g).

A mixture of (2S,4R)-1-(2-(6-bromo-3-(2,2,2-trifluoroacetyl)-1H-indol-1-yl)acetyl)-N-(3-chloro-2-fluorobenzyl)-4-fluoropyrrolidine-2-carboxamide 67 (0.1 g), diethyl phosphite (0.213 mL), Pd(PPh₃)₄ (38 mg), and TEA (46 μL) in DMF (2 mL) was sparged with argon gas. The reaction vessel was then sealed and subjected to microwave irradiation for 30 min at 100° C. The solvent was removed under reduced pressure and the crude product was purified by column chromatography (0-2.5% MeOH in DCM) to give diethyl (1-(2-((2S,4R)-2-((3-chloro-2-fluorobenzyl)carbamoyl)-4-fluoropyrrolidin-1-yl)-2-oxoethyl)-3-(2,2,2-trifluoroacetyl)-1H-indol-6-yl)phosphonate 68 (40 mg) as a light yellow solid.

Diethyl (1-(2-((2S,4R)-2-((3-chloro-2-fluorobenzyl)carbamoyl)-4-fluoropyrrolidin-1-yl)-2-oxoethyl)-3-(2,2,2-trifluoroacetyl)-1H-indol-6-yl)phosphonate 68 (40 mg) in dichloromethane (1 mL) was treated with TMSBr (1.1 mL) at rt for 2 d. The volatiles were removed under reduced pressure. The residue obtained was evaporated with 10% MeOH in DCM (10 mL). The remaining solid was triturated with tert-butyl methyl ether to give 32 (30 mg) as a light tan solid. ¹H NMR (400 MHz, DMSO-d₆): (major rotamer) δ 1.91-2.18 (m, 1H), 2.67-2.89 (m, 1H), 3.87-4.53 (m, 4H), 5.45 (d, J=17.2 Hz, 1H), 5.52 (d, J=55.6 Hz, 1H), 5.67 (d, J=17.2 Hz, 1H), 7.03 (t, J=7.6 Hz, 1H), 7.24 (t, J=7.6 Hz, 1H), 7.41 (t, J=6.8 Hz, 2H), 7.69 (dd, J=12, 8 Hz, 2H), 7.99 (d, J=14.4 Hz, 1H), 8.27 (dd, J=8.4, 3.2 Hz, 1H), 8.58 (s, 1H), 8.62 (t, J=5.6 Hz, 1H). ¹⁹F NMR (376 MHz, DMSO-d₆): (major rotamer) δ−71.6, −121.7, −175.9. LC (method A): t_(R)=1.54 min. LC/MS (EI) m/z. found, 608 ([M+H]+).

Example 18. (2S,4R)—N-Benzyl-4-fluoropyrrolidine-2-carboxamide hydrochloride (70)

To a solution of (2S,4R)-1-(tert-butoxycarbonyl)-4-fluoropyrrolidine-2-carboxylic acid 34 (1 equiv) in DMF (10 vol) at 0° C. under nitrogen atmosphere was added benzyl amine (1.2 equiv), HATU (1.5 equiv) and DIPEA (3 equiv). The reaction mixture was stirred at room temperature for 3 h. After completion of the reaction, the reaction mixture was quenched with water (30 vol). The resulting mixture was extracted with DCM. The organic layer was washed with brine, dried over anhydrous Na₂SO₄, filtered and then concentrated. The residue was purified by column chromatography on silica gel using DCM/MeOH to afford tert-butyl (2S,4R)-2-(benzylcarbamoyl)-4-fluoropyrrolidine-1-carboxylate 69. To a solution of tert-butyl (2S,4R)-2-(benzylcarbamoyl)-4-fluoropyrrolidine-1-carboxylate 69 (1 equiv) in 1,4-dioxane (3 vol) at 0° C. under nitrogen atmosphere was added 4 N HCl in 1,4-dioxane (10 vol) and stirred at room temperature for 3 h. The reaction mixture was concentrated to afford (2S,4R)—N-benzyl-4-fluoropyrrolidine-2-carboxamide hydrochloride 70.

Example 19. 2-(3-Acetyl-5-(diethoxyphosphoryl)-1H-indol-1-yl)acetic acid (73)

To a solution of tert-butyl 2-(3-acetyl-5-bromo-1H-indol-1-yl)acetate 71 (1 equiv) in DMSO (10 vol) was added diethyl phosphonate (2.3 equiv), 1,4-Bis(diphenylphosphino)butane (0.1 equiv), Pd(OAc)₂ (0.1 equiv) and DIPEA (4 equiv). The reaction mixture was heated to 100° C. for 12 h. After completion of the reaction, the reaction mixture was quenched with water. The resulting mixture was extracted with EtOAc. The organic layer was washed with brine, dried over anhydrous Na₂SO₄, filtered and then concentrated. The residue was purified by column chromatography on silica gel using Hexane/EtOAc to give tert-butyl 2-(3-acetyl-5-(diethoxyphosphoryl)-1H-indol-1-yl)acetate 72.

To a solution of tert-butyl 2-(3-acetyl-5-(diethoxyphosphoryl)-1H-indol-1-yl)acetate 72 (1 equiv) in DCM (10 vol) at 0° C. under nitrogen atmosphere was added TFA (10 vol). The reaction mixture was heated to 50° C. for 3 h. After completion of the reaction, the reaction mixture was concentrated to give 2-(3-acetyl-5-(diethoxyphosphoryl)-1H-indol-1-yl)acetic acid 73.

Example 20. (3-Acetyl-1-(2-((2S,4R)-2-(benzylcarbamoyl)-4-fluoropyrrolidin-1-yl)-2-oxoethyl)-1H-indol-5-yl)phosphonic acid (75)

Step-1: Diethyl (3-acetyl-1-(2-((2S,4R)-2-(benzylcarbamoyl)-4-fluoropyrrolidin-1-yl)-2-oxoethyl)-1H-indol-5-yl)phosphonate (74)

To a solution of 2-(3-acetyl-5-(diethoxyphosphoryl)-1H-indol-1-yl)acetic acid (1 equiv) in DMF (10 vol) at 0° C. under nitrogen atmosphere was added (2S,4R)—N-benzyl-4-fluoropyrrolidine-2-carboxamide hydrochloride (1.2 equiv), HATU (1.5 equiv) and DIPEA (3 equiv). The reaction mixture was stirred at room temperature for 3 h. After completion of the reaction, the reaction mixture was quenched with water (30 vol). The resulting mixture was extracted with DCM. The organic layer was washed with brine, dried over anhydrous Na₂SO₄, filtered and then concentrated. The residue was purified by column chromatography on silica gel using DCM/MeOH to give diethyl (3-acetyl-1-(2-((2S,4R)-2-(benzylcarbamoyl)-4-fluoropyrrolidin-1-yl)-2-oxoethyl)-1H-indol-5-yl)phosphonate.

¹H NMR (400 MHz, DMSO-d₆) δ 8.65-8.52 (m, 2H), 8.39 (s, 1H), 7.63-7.60 (m, 1H), 7.54-7.49 (m, 1H), 7.36-7.34 (m, 1H), 7.29-7.27 (m, 4H), 5.58-5.48 (m, 1H), 5.47-5.43 (m, 1H), 5.27-5.23 (m, 1H), 4.46-4.28 (m, 1H), 4.25-4.10 (m, 2H), 4.05-3.95 (m, 6H), 2.46 (s, 3H), 2.45-2.43 (m, 1H), 2.11-2.05 (m, 1H), 1.27-1.21 (m, 6H).

Step-2: (3-acetyl-1-(2-((2S,4R)-2-(benzylcarbamoyl)-4-fluoropyrrolidin-1-yl)-2-oxoethyl)-1H-indol-5-yl)phosphonic acid (75)

To a solution of diethyl (3-acetyl-1-(2-((2S,4R)-2-(benzylcarbamoyl)-4-fluoropyrrolidin-1-yl)-2-oxoethyl)-1H-indol-5-yl)phosphonate (1 equiv) in DCM (35 vol) at 0° C. under nitrogen atmosphere was added TMSBr (10 equiv). The reaction mixture was stirred at room temperature for 2 days. After completion of the reaction, the reaction mixture was quenched with water and the resulting solid was filtered and dried. The residue was purified by preparative HPLC to give (3-acetyl-1-(2-((2S,4R)-2-(benzylcarbamoyl)-4-fluoropyrrolidin-1-yl)-2-oxoethyl)-1H-indol-5-yl)phosphonic acid.

¹H NMR (400 MHz, DMSO-d₆) δ 8.64-8.52 (m, 2H), 8.31 (s, 1H), 7.54-7.51 (m, 2H), 7.34-7.20 (m, 5H), 5.57-5.42 (m, 1H), 5.43-5.39 (m, 1H), 5.23-5.19 (m, 1H), 4.46-4.42 (m, 1H), 4.33-4.16 (m, 3H), 3.97-3.85 (m, 1H), 2.45 (s, 3H), 2.46-2.44 (m, 1H), 2.19-2.01 (m, 1H).

Example 21. (2S,4R)-4-fluoro-N-phenethylpyrrolidine-2-carboxamide hydrochloride (77)

To a solution of (2S,4R)-1-(tert-butoxycarbonyl)-4-fluoropyrrolidine-2-carboxylic acid (1 equiv) in DMF (10 vol) at 0° C. under nitrogen atmosphere was added 2-phenylethan-1-amine (1.2 equiv), HATU (1.5 equiv) and DIPEA (3 equiv). The reaction mixture was stirred at room temperature for 3 h. After completion of the reaction, the reaction mixture was quenched with water (30 vol). The resulting mixture was extracted with DCM. The organic layer was washed with brine, dried over anhydrous Na₂SO₄, filtered and then concentrated. The residue was purified by column chromatography on silica gel using DCM/MeOH to afford tert-butyl (2S,4R)-4-fluoro-2-(phenethylcarbamoyl)pyrrolidine-1-carboxylate. To a solution of tert-butyl (2S,4R)-4-fluoro-2-(phenethylcarbamoyl)pyrrolidine-1-carboxylate (1 equiv) in 1,4-dioxane (3 vol) at 0° C. under nitrogen atmosphere was added 4 N HCl in 1,4-dioxane (10 vol) and stirred at room temperature for 3 h. The reaction mixture was concentrated to afford (2S,4R)-4-fluoro-N-phenethylpyrrolidine-2-carboxamide hydrochloride (77).

Example 22. (3-acetyl-1-(2-((2S,4R)-4-fluoro-2-(phenethylcarbamoyl)pyrrolidin-1-yl)-2-oxoethyl)-1H-indol-5-yl)phosphonic acid (79)

Step-1: Diethyl (3-acetyl-1-(2-((2S,4R)-4-fluoro-2-(phenethylcarbamoyl)pyrrolidin-1-yl)-2-oxoethyl)-1H-indol-5-yl)phosphonate (78)

To a solution of 2-(3-acetyl-5-(diethoxyphosphoryl)-1H-indol-1-yl)acetic acid (1 equiv) in DMF (10 vol) at 0° C. under nitrogen atmosphere was added (2S,4R)-4-fluoro-N-phenethylpyrrolidine-2-carboxamide hydrochloride (1.2 equiv), HATU (1.5 equiv) and DIPEA (3 equiv). The reaction mixture was stirred at room temperature for 3 h. After completion of the reaction, the reaction mixture was quenched with water (30 vol). The resulting mixture was extracted with DCM. The organic layer was washed with brine, dried over anhydrous Na₂SO₄, filtered and then concentrated. The residue was purified by column chromatography on silica gel using DCM/MeOH to give diethyl (3-acetyl-1-(2-((2S,4R)-4-fluoro-2-(phenethylcarbamoyl)pyrrolidin-1-yl)-2-oxoethyl)-1H-indol-5-yl)phosphonate.

¹H NMR (400 MHz, DMSO-d₆) δ 8.62-8.59 (m, 2H), 8.39 (s, 1H), 8.09-8.07 (s, 1H), 7.61-7.52 (m, 2H), 7.21-7.13 (m, 4H), 5.56-5.25 (m, 3H), 4.34-4.33 (m, 1H), 3.99-3.93 (m, 8H), 2.66-2.62 (m, 2H), 2.46 (s, 3H), 2.45-2.44 (m, 1H), 2.02-1.98 (m, 1H), 1.21-1.17 (m, 6H).

Step-2: (3-Acetyl-1-(2-((2S,4R)-4-fluoro-2-(phenethylcarbamoyl)pyrrolidin-1-yl)-2-oxoethyl)-1H-indol-5-yl)phosphonic acid (79)

To a solution of diethyl (3-acetyl-1-(2-((2S,4R)-4-fluoro-2-(phenethylcarbamoyl)pyrrolidin-1-yl)-2-oxoethyl)-1H-indol-5-yl)phosphonate (1 equiv) in DCM (35 vol) at 0° C. under nitrogen atmosphere was added TMSBr (10 equiv). The reaction mixture was stirred at room temperature for 2 days. After completion of the reaction, the reaction mixture was quenched with water and the resulting solid was filtered and dried. The residue was purified by preparative HPLC to give (3-acetyl-1-(2-((2S,4R)-4-fluoro-2-(phenethylcarbamoyl)pyrrolidin-1-yl)-2-oxoethyl)-1H-indol-5-yl)phosphonic acid.

¹H NMR (400 MHz, DMSO-d₆) δ 8.61-8.58 (m, 1H), 8.27 (s, 1H), 8.09 (s, 1H), 7.53-7.50 (m, 2H), 7.22-7.15 (m, 5H), 5.52-5.34 (m, 2H), 5.21-5.17 (m, 1H), 4.35-4.31 (m, 1H), 4.11-4.06 (m, 1H), 3.91-3.82 (m, 2H), 3.31-3.24 (m, 1H), 3.15-3.12 (m, 2H), 2.66-2.60 (m, 2H), 2.44 (s, 3H), 2.43-2.41 (m, 1H), 2.05-1.98 (m, 1H).

Example 23. (2S,4R)-4-Fluoro-N-(3-phenylpropyl)pyrrolidine-2-carboxamidehydrochloride (81)

To a solution of (2S,4R)-1-(tert-butoxycarbonyl)-4-fluoropyrrolidine-2-carboxylic acid (1 equiv) in DMF (10 vol) at 0° C. under nitrogen atmosphere was added 3-phenylpropan-1-amine (1.2 equiv), HATU (1.5 equiv) and DIPEA (3 equiv). The reaction mixture was stirred at room temperature for 3 h. After completion of the reaction, the reaction mixture was quenched with water (30 vol). The resulting mixture was extracted with DCM. The organic layer was washed with brine, dried over anhydrous Na₂SO₄, filtered and then concentrated. The residue was purified by column chromatography on silica gel using DCM/MeOH to afford tert-butyl (2S,4R)-4-fluoro-2-((3-phenylpropyl)carbamoyl)pyrrolidine-1-carboxylate. To a solution of tert-butyl (2S,4R)-4-fluoro-2-((3-phenylpropyl)carbamoyl)pyrrolidine-1-carboxylate (1 equiv) in 1,4-dioxane (3 vol) at 0° C. under nitrogen atmosphere was added 4 N HCl in 1,4-dioxane (10 vol) and stirred at room temperature for 3 h. The reaction mixture was concentrated to afford (2S,4R)-4-fluoro-N-(3-phenylpropyl)pyrrolidine-2-carboxamidehydrochloride (81).

Example 24. (3-Acetyl-1-(2-((2S,4R)-4-fluoro-2-((3-phenylpropyl)carbamoyl)pyrrolidin-1-yl)-2-oxoethyl)-1H-indol-5-yl)phosphonic acid (83)

Step-1: Diethyl (3-acetyl-1-(2-((2S,4R)-4-fluoro-2-((3-phenylpropyl)carbamoyl)pyrrolidin-1-yl)-2-oxoethyl)-1H-indol-5-yl)phosphonate (82)

To a solution of 2-(3-acetyl-5-(diethoxyphosphoryl)-1H-indol-1-yl)acetic acid (1 equiv) in DMF (10 vol) at 0° C. under nitrogen atmosphere was added (2S,4R)-4-fluoro-N-(3-phenylpropyl)pyrrolidine-2-carboxamidehydrochloride (1.2 equiv), HATU (1.5 equiv) and DIPEA (3 equiv). The reaction mixture was stirred at room temperature for 3 h. After completion of the reaction, the reaction mixture was quenched with water (30 vol). The resulting mixture was extracted with DCM. The organic layer was washed with brine, dried over anhydrous Na₂SO₄, filtered and then concentrated. The residue was purified by column chromatography on silica gel using DCM/MeOH to give diethyl (3-acetyl-1-(2-((2S,4R)-4-fluoro-2-((3-phenylpropyl)carbamoyl)pyrrolidin-1-yl)-2-oxoethyl)-1H-indol-5-yl)phosphonate.

¹H NMR (400 MHz, MeOD) δ 8.81-8.77 (m, 1H), 8.28 (s, 1H), 7.66-7.63 (m, 2H), 7.17-7.06 (m, 5H), 5.56-5.37 (m, 2H), 5.25-5.21 (m, 1H), 4.54-4.53 (m, 1H), 4.12-4.03 (m, 8H), 3.31-3.21 (m, 2H), 2.58-2.57 (m, 1H), 2.51 (s, 3H), 2.25-2.11 (m, 1H), 1.75-1.74 (m, 2H), 1.34-1.29 (m, 6H).

Step-2: (3-Acetyl-1-(2-((2S,4R)-4-fluoro-2-((3-phenylpropyl)carbamoyl)pyrrolidin-1-yl)-2-oxoethyl)-1H-indol-5-yl)phosphonic acid (84)

To a solution of diethyl (3-acetyl-1-(2-((2S,4R)-4-fluoro-2-((3-phenylpropyl)carbamoyl)pyrrolidin-1-yl)-2-oxoethyl)-1H-indol-5-yl)phosphonate (1 equiv) in DCM (35 vol) at 0° C. under nitrogen atmosphere was added TMSBr (10 equiv). The reaction mixture was stirred at room temperature for 2 days. After completion of the reaction, the reaction mixture was quenched with water and the resulting solid was filtered and dried. The residue was purified by preparative HPLC to give (3-acetyl-1-(2-((2S,4R)-4-fluoro-2-((3-phenylpropyl)carbamoyl)pyrrolidin-1-yl)-2-oxoethyl)-1H-indol-5-yl)phosphonic acid.

¹H NMR (400 MHz, DMSO-d₆) δ 8.63-8.59 (m, 1H), 8.31 (s, 1H), 8.03-8.02 (m, 1H), 7.53 (d, J=5.6 Hz, 2H), 7.20-7.09 (m, 5H), 5.56-5.41 (m, 1H), 5.42-5.37 (m, 1H), 5.22-5.18 (m, 1H), 4.37-4.33 (m, 1H), 4.17-4.08 (m, 2H), 3.95-3.85 (m, 2H), 2.99-2.96 (m, 2H), 2.49 (s, 3H), 2.40-2.38 (m, 1H), 2.09-1.97 (m, 1H), 1.65-1.62 (m, 2H).

Example 25. (2S,4R)-4-Fluoro-N-(4-phenylbutyl)pyrrolidine-2-carboxamide (85)

To a solution of (2S,4R)-1-(tert-butoxycarbonyl)-4-fluoropyrrolidine-2-carboxylic acid (1 equiv) in DMF (10 vol) at 0° C. under nitrogen atmosphere was added 4-phenylbutan-1-amine (1.2 equiv), HATU (1.5 equiv) and DIPEA (3 equiv). The reaction mixture was stirred at room temperature for 3 h. After completion of the reaction, the reaction mixture was quenched with water (30 vol). The resulting mixture was extracted with DCM. The organic layer was washed with brine, dried over anhydrous Na₂SO₄, filtered and then concentrated. The residue was purified by column chromatography on silica gel using DCM/MeOH to afford tert-butyl (2S,4R)-4-fluoro-2-((4-phenylbutyl)carbamoyl)pyrrolidine-1-carboxylate. To a solution of tert-butyl (2S,4R)-4-fluoro-2-((4-phenylbutyl)carbamoyl)pyrrolidine-1-carboxylate (1 equiv) in 1,4-dioxane (3 vol) at 0° C. under nitrogen atmosphere was added 4 N HCl in 1,4-dioxane (10 vol) and stirred at room temperature for 3 h. The reaction mixture was concentrated to afford (2S,4R)-4-fluoro-N-(4-phenylbutyl)pyrrolidine-2-carboxamide. (85)

Example 26. (3-acetyl-1-(2-((2S,4R)-4-fluoro-2-((4-phenylbutyl)carbamoyl)pyrrolidin-1-yl)-2-oxoethyl)-1H-indol-5-yl)phosphonic acid (87)

Step-1: Diethyl (3-acetyl-1-(2-((2S,4R)-4-fluoro-2-((4-phenylbutyl)carbamoyl)pyrrolidin-1-yl)-2-oxoethyl)-1H-indol-5-yl)phosphonate (86)

To a solution of 2-(3-acetyl-5-(diethoxyphosphoryl)-1H-indol-1-yl)acetic acid (1 equiv) in DMF (10 vol) at 0° C. under nitrogen atmosphere was added (2S,4R)-4-fluoro-N-(4-phenylbutyl)pyrrolidine-2-carboxamide (1.2 equiv), HATU (1.5 equiv) and DIPEA (3 equiv). The reaction mixture was stirred at room temperature for 3 h. After completion of the reaction, the reaction mixture was quenched with water (30 vol). The resulting mixture was extracted with DCM. The organic layer was washed with brine, dried over anhydrous Na₂SO₄, filtered and then concentrated. The residue was purified by column chromatography on silica gel using DCM/MeOH to give diethyl (3-acetyl-1-(2-((2S,4R)-4-fluoro-2-((4-phenylbutyl)carbamoyl)pyrrolidin-1-yl)-2-oxoethyl)-1H-indol-5-yl)phosphonate (86).

¹H NMR (400 MHz, DMSO-d₆) δ 8.64-8.59 (m, 1H), 8.38 (s, 1H), 7.96-7.93 (m, 1H), 7.63-7.61 (m, 1H), 7.55-7.50 (m, 1H), 7.19-7.06 (m, 5H), 5.54-5.42 (m, 1H), 5.41-5.38 (m, 1H), 5.28-5.20 (m, 1H), 4.32 (t, J=8.4 Hz, 1H), 4.11-3.92 (m, 8H), 3.32-3.29 (m, 2H), 2.39 (s, 3H), 2.38-2.36 (m, 1H), 2.12-2.01 (m, 1H), 1.48-1.37 (m, 2H), 1.35-1.32 (m, 2H), 1.22-1.18 (m, 6H).

Step-2: (3-Acetyl-1-(2-((2S,4R)-4-fluoro-2-((4-phenylbutyl)carbamoyl)pyrrolidin-1-yl)-2-oxoethyl)-1H-indol-5-yl)phosphonic acid (87)

To a solution of diethyl (3-acetyl-1-(2-((2S,4R)-4-fluoro-2-((4-phenylbutyl)carbamoyl)pyrrolidin-1-yl)-2-oxoethyl)-1H-indol-5-yl)phosphonate (1 equiv) in DCM (35 vol) at 0° C. under nitrogen atmosphere was added TMSBr (10 equiv). The reaction mixture was stirred at room temperature for 2 days. After completion of the reaction, the reaction mixture was quenched with water and the resulting solid was filtered and dried. The residue was purified by preparative HPLC to give (3-acetyl-1-(2-((2S,4R)-4-fluoro-2-((4-phenylbutyl)carbamoyl)pyrrolidin-1-yl)-2-oxoethyl)-1H-indol-5-yl)phosphonic acid.

¹H NMR (400 MHz, DMSO-d₆) δ 8.63-8.59 (m, 1H), 8.32 (s, 1H), 7.96 (t, J=5.6 Hz, 1H), 7.54-7.51 (m, 2H), 7.23-7.07 (m, 5H), 5.54-5.41 (m, 1H), 5.40-5.35 (m, 1H), 5.22-5.17 (m, 1H), 4.35-4.13 (m, 1H), 4.12-4.07 (m, 1H), 3.93-3.82 (m, 3H), 3.09-3.06 (m, 1H), 2.99-2.96 (m, 1H), 2.45 (s, 3H), 2.44-2.38 (m, 1H), 2.12-2.02 (m, 1H), 1.52-1.47 (m, 2H), 1.37-1.33 (m, 2H).

Example 27. N-(2-((2R,4R)-4-Fluoropyrrolidin-2-yl)ethyl)benzenesulfonamide hydrochloride (94)

To a solution of (2S,4R)-1-(tert-butoxycarbonyl)-4-fluoropyrrolidine-2-carboxylic acid (1 equiv) in THF (10 vol) at 0° C. was added boron hydride-tetrahydrofuran complex (2.1 equiv). The reaction mixture was stirred at room temperature for 2 h and then cooled at 0° C. The resulting mixture was quenched with saturated K₂CO₃ solution and extracted with ethyl acetate. The organic layer was separated, dried over anhydrous Na₂SO₄, filtered and then concentrated. The residue was purified by column chromatography on silica gel using DCM/MeOH to afford the compound (89).

To a solution of tert-butyl (2S,4R)-4-fluoro-2-(hydroxymethyl)pyrrolidine-1-carboxylate (1 equiv) in DCM (20 Vol) at 0° C. was added methane sulfonyl chloride (1.5 equiv) and triethylamine (3 equiv). The reaction mixture was stirred at 0° C. for 1 h. The resulting mixture was diluted with ethyl acetate, washed with 1N HCl and saturated NaHCO₃ solution. The organic layer was separated, dried over anhydrous Na₂SO₄, filtered and then concentrated. Crude tert-butyl (2S,4R)-4-fluoro-2-(((methylsulfonyl)oxy)methyl)pyrrolidine-1-carboxylate (90) was dissolved in DMSO (10 Vol) and sodium cyanide (3 equiv) was added. The reaction mixture was stirred at 50° C. for 15 h. The resulting mixture was cooled to room temperature and quenched with water and was extracted with ethyl acetate. The organic layer was separated, dried over anhydrous Na₂SO₄, filtered and then concentrated. The residue was purified by column chromatography on silica gel using Hexane/EtOAc to give tert-butyl (2R,4R)-2-(cyanomethyl)-4-fluoropyrrolidine-1-carboxylate (91).

To a solution of tert-butyl (2R,4R)-2-(cyanomethyl)-4-fluoropyrrolidine-1-carboxylate (1 equiv) in methanol (5 Vol) was added raney Ni (1.2 equiv) and triethylamine (2 equiv). The reaction mixture was stirred at room temperature at 3.5 milli bar pressure under hydrogen atmosphere for 16 h. The resulting mixture wasfiltered and then concentrated. The residue was purified by column chromatography on silica gel using DCM/MeOH to give tert-butyl (2R,4R)-2-(2-aminoethyl)-4-fluoropyrrolidine-1-carboxylate (92).

To a solution of tert-butyl (2R,4R)-2-(2-aminoethyl)-4-fluoropyrrolidine-1-carboxylate (1 equiv) in THF (10 vol) at 0° C. under nitrogen atmosphere was added benzene sulfonyl chloride (1.5 equiv) and triethylamine (3 equiv). The reaction mixture was stirred at room temperature for 16 h and then concentrated. The residue was purified by column chromatography on silica gel using Hexane/EtOAc to give tert-butyl (2R,4R)-4-fluoro-2-(2-(phenyl sulfonamido)ethyl)pyrrolidine-1-carboxylate (92).

To a solution of tert-butyl (2R,4R)-4-fluoro-2-(2-(phenylsulfonamido)ethyl)pyrrolidine-1-carboxylate (1 equiv) in 1,4-dioxane (2 vol) at 0° C. was added 4 N HCl in dioxane (10 vol). The reaction mixture was stirred at room temperature for 4 h and then concentrated. The residue was taken in MTBE and stirred for 30 min. The resultant solid was filtered and dried to give N-(2-((2R,4R)-4-fluoropyrrolidin-2-yl)ethyl)benzenesulfonamide hydrochloride (93).

Example 28. (3-Acetyl-1-(2-((2R,4R)-4-fluoro-2-(2-(phenylsulfonamido)ethyl)pyrrolidin-1-yl)-2-oxoethyl)-1H-indol-5-yl)phosphonic acid (96)

Step-1: Diethyl (3-acetyl-1-(2-((2R,4R)-4-fluoro-2-(2-(phenylsulfonamido)ethyl)pyrrolidin-1-yl)-2-oxoethyl)-1H-indol-5-yl)phosphonate (95)

To a solution of (3-acetyl-1-(2-((2S,4R)-4-fluoro-2-((3-phenylpropyl)carbamoyl)pyrrolidin-1-yl)-2-oxoethyl)-1H-indol-5-yl)phosphonic acid (1 equiv) in DMF (10 vol) at 0° C. under nitrogen atmosphere was added N-(2-((2R,4R)-4-fluoropyrrolidin-2-yl)ethyl)benzenesulfonamide hydrochloride (1.2 equiv), HATU (1.5 equiv) and DIPEA (3 equiv). The reaction mixture was stirred at room temperature for 3 h. After completion of the reaction, the reaction mixture was quenched with water (30 vol). The resulting mixture was extracted with DCM. The organic layer was washed with brine, dried over anhydrous Na₂SO₄, filtered and then concentrated. The residue was purified by column chromatography on silica gel using DCM/MeOH to give diethyl (3-acetyl-1-(2-((2R,4R)-4-fluoro-2-(2-(phenyl sulfonamido)ethyl)pyrrolidin-1-yl)-2-oxoethyl)-1H-indol-5-yl)phosphonate.

¹H NMR (400 MHz, DMSO-d₆) δ 8.65-8.61 (m, 1H), 8.41 (s, 1H), 7.75 (d, J=7.0 Hz, 2H), 7.63-7.53 (m, 5H), 5.45-5.38 (m, 1H), 5.37-5.33 (m, 1H), 5.21-5.16 (m, 1H), 4.21-3.95 (m, 6H), 3.81-3.65 (m, 1H), 2.74-2.69 (m, 2H), 2.48 (s, 3H), 2.33-2.32 (m, 1H), 2.04-2.02 (m, 1H), 1.98-1.91 (m, 1H), 1.52-1.51 (m, 1H), 1.25-1.21 (m, 6H).

Step-2: (3-Acetyl-1-(2-((2R,4R)-4-fluoro-2-(2-(phenylsulfonamido)ethyl)pyrrolidin-1-yl)-2-oxoethyl)-1H-indol-5-yl)phosphonic acid (96)

To a solution of diethyl (3-acetyl-1-(2-((2R,4R)-4-fluoro-2-(2-(phenylsulfonamido)ethyl)pyrrolidin-1-yl)-2-oxoethyl)-1H-indol-5-yl)phosphonate (1 equiv) in DCM (35 vol) at 0° C. under nitrogen atmosphere was added TMSBr (10 equiv). The reaction mixture was stirred at room temperature for 2 days. After completion of the reaction, the reaction mixture was quenched with water and the resulting solid was filtered and dried. The residue was purified by preparative HPLC to give (3-acetyl-1-(2-((2R,4R)-4-fluoro-2-(2-(phenylsulfonamido)ethyl)pyrrolidin-1-yl)-2-oxoethyl)-1H-indol-5-yl)phosphonic acid.

¹H NMR (400 MHz, MeOD) δ 8.85-8.81 (m, 1H), 8.25 (s, 1H), 7.80 (d, J=7.2 Hz, 2H), 7.79-7.72 (m, 1H), 7.61-7.48 (m, 4H), 5.40-5.31 (m, 1H), 5.30-5.27 (m, 1H), 5.18-5.14 (m, 1H), 4.27-4.24 (m, 1H), 4.14-4.09 (m, 1H), 3.88-3.78 (m, 1H), 2.90-2.83 (m, 2H), 2.44 (s, 3H), 2.43-2.41 (m, 1H), 2.04-1.96 (m, 2H), 1.76-1.71 (m, 1H).

Example 29. (S)—N-(6-Methylpyridin-2-yl)azetidine-2-carboxamide hydrochloride (99)

To a solution of (S)-1-(tert-butoxycarbonyl)azetidine-2-carboxylic acid (1 equiv) in DCM (10 vol) at 0° C. under nitrogen atmosphere was added Ghosez's reagent. The reaction mixture was stirred at same temperature for 3 h and then 6-methylpyridin-2-amine (1 equiv), DIPEA (3 equiv) was added to the reaction mixture and the reaction mixture was stirred at room temperature for 16 h. After completion of the reaction, the reaction mixture was quenched with water (30 vol). The resulting mixture was extracted with DCM. The organic layer was washed with brine, dried over anhydrous Na₂SO₄, filtered and then concentrated. The residue was purified by column chromatography on silica gel using Hexane/EtOAc to give compound tert-butyl (S)-2-((6-methylpyridin-2-yl)carbamoyl)azetidine-1-carboxylate. To a solution of compound tert-butyl (S)-2-((6-methylpyridin-2-yl)carbamoyl)azetidine-1-carboxylate (1 equiv) in 1,4-dioxane (3 vol) at 0° C. under nitrogen atmosphere was added 4 N HCl in 1,4-dioxane (10 vol) and stirred at room temperature for 3 h and then concentrated. The residue was taken in MTBE and stirred for 30 min. The resultant solid was filtered and dried to give (S)—N-(6-methylpyridin-2-yl)azetidine-2-carboxamide hydrochloride (99).

Example 30. (S)-(3-Acetyl-1-(2-(2-((6-methylpyridin-2-yl)carbamoyl)azetidin-1-yl)-2-oxoethyl)-1H-indol-5-yl)phosphonic acid (101)

Step-1: Diethyl (S)-(3-acetyl-1-(2-(2-((6-methylpyridin-2-yl)carbamoyl)azetidin-1-yl)-2-oxoethyl)-1H-indol-5-yl)phosphonate (100)

To a solution of of (3-acetyl-1-(2-((2S,4R)-4-fluoro-2-((3-phenylpropyl)carbamoyl)pyrrolidin-1-yl)-2-oxoethyl)-1H-indol-5-yl)phosphonic acid (1 equiv) in DMF (10 vol) at 0° C. under nitrogen atmosphere was added (S)—N-(6-methylpyridin-2-yl)azetidine-2-carboxamide hydrochloride (1.2 equiv), HATU (1.5 equiv) and DIPEA (3 equiv). The reaction mixture was stirred at room temperature for 3 h. After completion of the reaction, the reaction mixture was quenched with water (30 vol). The resulting mixture was extracted with DCM. The organic layer was washed with brine, dried over anhydrous Na₂SO₄, filtered and then concentrated. The residue was purified by column chromatography on silica gel using DCM/MeOH to give diethyl (S)-(3-acetyl-1-(2-(2-((6-methylpyridin-2-yl)carbamoyl)azetidin-1-yl)-2-oxoethyl)-1H-indol-5-yl)phosphonate.

¹H NMR (400 MHz, DMSO-d₆) δ 10.48 (s, 1H), 8.62-8.59 (m, 1H), 8.41 (s, 1H), 7.90-7.88 (m, 1H), 7.74-7.52 (m, 3H), 6.96 (d, J=7.2 Hz, 1H), 5.31-5.10 (m, 2H), 5.01-4.97 (m, 1H), 4.33-4.28 (m, 1H), 4.03-3.85 (m, 5H), 2.49 (s, 3H), 2.46 (s, 3H), 2.41-2.36 (m, 2H), 1.23-1.19 (m, 6H).

Step-2: (S)-(3-acetyl-1-(2-(2-((6-methylpyridin-2-yl)carbamoyl)azetidin-1-yl)-2-oxoethyl)-1H-indol-5-yl)phosphonic acid

To a solution of diethyl (S)-(3-acetyl-1-(2-(2-((6-methylpyridin-2-yl)carbamoyl)azetidin-1-yl)-2-oxoethyl)-1H-indol-5-yl)phosphonate (1 equiv) in DCM (35 vol) at 0° C. under nitrogen atmosphere was added TMSBr (10 equiv). The reaction mixture was stirred at room temperature for 2 days. After completion of the reaction, the reaction mixture was quenched with water and the resulting solid was filtered and dried. The residue was purified by preparative HPLC to give (S)-(3-acetyl-1-(2-(2-((6-methylpyridin-2-yl)carbamoyl)azetidin-1-yl)-2-oxoethyl)-1H-indol-5-yl)phosphonic acid.

¹H NMR (400 MHz, MeOD) δ 8.84-8.80 (m, 1H), 8.20 (s, 1H), 8.03-7.81 (m, 1H), 7.77-7.71 (m, 1H), 7.61-7.55 (m, 1H), 7.52-7.48 (m, 1H), 7.01-6.98 (m, 1H), 5.17-5.05 (m, 3H), 4.27-4.23 (m, 1H), 4.00-3.91 (m, 1H), 2.55 (s, 3H), 2.48 (s, 3H), 2.36-2.34 (m, 2H).

Example 31. (1R,3S,4S)—N-(6-methylpyridin-2-yl)-2-azabicyclo[2.2.1]heptane-3-carboxamide hydrochloride (115)

Step 1: (R,E)-ethyl 2-((1-phenylethyl)imino)acetate (108)

To a solution of compound 107 (15 g, 0.12 mol) in diethyl ether (200 mL) was added Na₂SO₄ (42.6 g, 0.3 mol) and ethyl glyoxalate (18.36 g, 0.12 mmol) at 0° C. After addition, the reaction was stirred at room temperature for 16 hrs. The reaction filtered and the filtrated was concentrated under reduced pressure to give the title compound (23 g, 90.6% yield) as a colorless oil.

Step 2: (1S,3S,4R)-ethyl 2-((R)-1-phenylethyl)-2-azabicyclo[2.2.1]hept-5-ene-3-carboxylate (109)

To a solution of compound 108 (23 g, 0.11 mol) in DMF (200 mL) was added 1, 3-Cyclopentadiene (18.48 g, 0.24 mmol) and trifluoroacetic acid (16 g, 0.14 mmol) at 0° C. After addition, the reaction was stirred at room temperature for 16 hrs. The mixture was diluted with EtOAc and washed with 10% aq. LiCl solution and brine successively, dried over anhydrous Na₂SO₄, filtered and then concentrated. The residue was purified by column chromatography on silica gel (eluted with petroleum ether:ethyl acetate=60:1) to give the title compound (17 g, 57% yield) as a colorless oil. LC/MS (ESI) m/z: 272 [M+H]⁺.

Step 3: (1R,3S,4S)-ethyl 2-((R)-1-phenylethyl)-2-azabicyclo[2.2.1]heptane-3-carboxylate (110)

To a solution of compound 109 (6 g, 22.1 mmol) in EtOH (60 mL) was added Pd/C (5% wt, 0.3 g) and the mixture was degassed under N₂ atmosphere for three times and stirred under H₂ balloon at room temperature for 1 hr. The mixture was filtered through Celite and the filter cake was washed with EtOH. To the filtrate, conc. HCl solution (7 mL) was added and then the mixture was concentrated to dryness under reduced pressure. The procedure was repeated several times until a semi-crystalline residue was formed. The residue was stirred in Et₂O/i-PrOH (50 mL, 5:1) at 0° C. for 1 hr. The mixture was filtered and the filter cake was dried under vacuum to give the title compound (5 g, 82.8% yield) as white solid. LC/MS (ESI) m/z: 274 [M+H]⁺.

Step 4: (1R,3S,4S)-ethyl 2-azabicyclo[2.2.1]heptane-3-carboxylate (111)

To a solution of compound 110 (5 g, 18.3 mmol) in ethanol (10 mL) was degassed under N₂ atmosphere for three times and Pd(OH)₂ (500 mg, 10% wt) was added. The mixture was degassed again and stirred under H₂ balloon at room temperature for 16 hrs. The mixture was filtered and the filtrate was concentrated under reduced pressure to give the title compound (3.3 g, 98.5% yield) as a colorless oil. LC/MS (ESI) m/z: 170 [M+H]⁺.

Step 5: (1R,3S,4S)-2-tert-butyl 3-ethyl 2-azabicyclo[2.2.1]heptane-2,3-dicarboxylate (112)

To a solution of compound 111 (3.3 g, 18 mmol) was in DCM (30 mL) was added triethylamine (7.5 mL, 54 mmol) and Di-tert-butyl dicarbonate (7.85 g, 36 mmol) at room temperature. After addition, the reaction was stirred at room temperature for 16 hrs. The mixture was diluted with DCM and washed with water and brine, dried over anhydrous Na₂SO₄, filtered and then concentrated. The residue was purified by column chromatography on silica gel (eluted with petroleum ether:ethyl acetate=20:1) to give the title compound (3.6 g, 71% yield) as a colorless oil. LC/MS (ESI) m/z: 214 [M+H-56]⁺.

Step 6: (1R,3S,4S)-2-(tert-butoxycarbonyl)-2-azabicyclo[2.2.1]heptane-3-carboxylic acid (113)

To a solution of compound 112 (3.6 g, 0.18 mmol) in THF (20 mL) and was added aq.NaOH solution (27 mL, 0.54 mmol, 2M) at room temperature. After addition, the reaction was stirred at room temperature for 16 hrs. The resulting mixture was washed with ethyl acetate (20 mL×2) and the aqueous phase was adjust to pH=3 with aq. HCl (1 mmol/L). The aqueous layer was extracted with DCM twice. The combined organic phases dried over anhydrous Na₂SO₄, filtered and then concentrated to give the title compound (3.2 g, 99.2% yield) as white solid. LC/MS (ESI) m/z: 186 [M+H-56]⁺.

Step 7: (1R,3S,4S)-tert-butyl3-((6-methylpyridin-2-yl)carbamoyl)-2-azabicyclo[2.2.1]heptane-2-carboxylate (114)

To a solution of compound 113 (2 g, 8.3 mmol) was in 1,2-Dichloroethane (20 ml) was added N-Ethoxycarbonyl-2-ethoxy-1,2-dihydroquinoline (4.1 g, 16.6 mmol) and 2-Amino-6-methylpyridine (0.9 g, 8.3 mmol) at 0° C. After addition, the reaction was stirred at 85° C. for 16 hrs. The mixture was concentrated to dryness to five crude product, which was purified by column chromatography on silica gel (eluted with petroleum ether:ethyl acetate=10:1) to give the title compound (2.1 g, 79% yield) as white solid. LC/MS (ESI) m/z: 276 [M+H-56]⁺.

Step 8: (1R,3S,4S)—N-(6-methylpyridin-2-yl)-2-azabicyclo[2.2.1]heptane-3-carboxamide (115)

To a solution compound 114 (2.1 g, 6.5 mmol) in dioxane (15 mL) was added HCl dioxane solutions (15 mL) was at 0° C. The mixture was stirred at room temperature for 3 hrs. The mixture was concentrated to dryness to give the title compound 115 (2.3 g, 99.7% yield) as a yellow solid, which was directly used to the next reaction without purification. LC/MS (ESI) m/z: 232 [M+H]⁺.

Example 32. 2-(3-carbamoyl-5-(diethoxyphosphoryl)-1H-indol-1-yl)acetic acid (122)

Step 1: tert-butyl 5-bromo-1H-indole-1-carboxylate (117)

To a solution of compound 116 (30 g, 0.15 mol) in DCM (300 mL) was added Et₃N (64 mL, 0.46 mol), DMAP (5.6 g, 0.046 mol), then Boc₂O (50 g, 0.23 mol) was added in portions at 0° C. After addition, the reaction was stirred at room temperature for 16 hrs. The mixture was diluted with DCM (200 mL) and washed with water and brine, dried over anhydrous Na₂SO₄, filtered and concentrated to dryness. The residue was purified by column chromatography on silica gel (eluted with Petroleum ether:Ethyl acetate=50:1) to give the title compound (44 g, 97% yield) as white solid. LC/MS (ESI) m/z: 240 (M-56+H)⁺.

Step 2: tert-butyl 5-bromo-3-carbamoyl-1H-indole-1-carboxylate (118)

To a solution of compound 117 (10 g, 33.7 mmol) in MeCN (100 mL) was added chlorosulfonyl isocyanate (3.1 mL, 35.6 mmol) dropwise at 0° C. The reaction was stirred at room temperature overnight. Acetone (200 mL) and H₂O (25 mL) was added dropwise at 0° C. followed by addition of aq.KOH solution (5 mL, 10% wt). The reaction was stirred at room temperature for 30 min and extracted with EtOAc (50 mL×2). The combined organic phases are washed with brine, dried over anhydrous Na₂SO₄, and then concentrated to give the compound (7.4 g, 64.8% yield) as white solid. LC/MS (ESI) m/z: 339 (M+H).

Step 3: tert-butyl 3-carbamoyl-5-(diethoxyphosphoryl)-1H-indole-1-carboxylate (119)

To a mixture of compound 118 (1 g, 2.95 mmol), diethyl phosphonate (2.03 g, 14.7 5 mmol) and Et₃N (900 mg, 8.85 mmol) in EtOH (20 mL) was added Pd(PPh₃)₄ (345 mg, 0.3 mmol) under N₂ atmosphere. The mixture was degassed under N₂ for three times and the reaction was stirred at reflux for 24 hrs under N₂ atmosphere. The mixture was concentrated to dryness and the residue was diluted with EtOAc, washed with water and brine, dried over anhydrous sodium sulfate, filtered, and concentrated to give crude product, which was purified by silica gel column with eluted with (DCM/MeOH=30/1) to give the title compound (600 mg, 51.2% yield) as yellow solid. LC/MS (ESI) m/z: 397 (M+H).

Step 4: diethyl (3-carbamoyl-1H-indol-5-yl)phosphonate TFA salt (120)

To a solution of the compound 119 (600 mg, 1.51 mmol) in DCM (10 mL) was added TFA (2 mL). The reaction was stirred at room temperature for 2 hrs. The mixture was concentrated to dryness to give a residue, which was washed with diethyl ether and dried under vacuum to give the title compound (560 mg, 94.3% yield) as white solid. LC/MS (ESI) m/z: 297 (M+H)⁺.

Step 5: tert-butyl 2-(3-carbamoyl-5-(diethoxyphosphoryl)-1H-indol-1-yl)acetate (121)

To a solution of the compound 120 (400 mg, 1.01 mmol) and tert-butyl 2-bromoacetate (297 mg, 1.52 mmol) in DMF (8 mL) was added K₂CO₃ (223 mg, 1.62 mmol). The reaction was stirred at room temperature for 16 hrs. The mixture was diluted with EtOAc and washed with water and brine, dried over anhydrous sodium sulfate, filtered, and concentrated. The residue was purified by silica gel column eluted with (DCM/MeOH=25/1) to give the title compound (390 mg, 94.1% yield) as yellow solid. LC/MS (ESI) m/z: 411 (M+H)⁺.

Step 6: 2-(3-carbamoyl-5-(diethoxyphosphoryl)-1H-indol-1-yl)acetic acid (122)

To a solution of the compound 121 (200 mg, 0.48 mmol) in DCM (6 mL) was added TFA (2 mL) and the mixture was stirred at room temperature for 2 hrs. The mixture was concentrated to dryness and washed with diethyl ether to give 122 (205 mg, 100% yield) as yellow solid, which was directly used to the next reaction. LC/MS (ESI) m/z: 311 (M+H)⁺.

Example 33. diethyl (3-carbamoyl-1-(2-((1R,3S,4S)-3-((6-methylpyridin-2-yl)carbamoyl)-2-azabicyclo[2.2.1]heptan-2-yl)-2-oxoethyl)-1H-indol-5-yl)phosphonate (102)

To a solution of compound 122 in DMF was added DIPEA and HATU at room temperature. After the reaction was stirred for 10 min, compound 115 was added. The reaction was stirred at room temperature overnight and then diluted with water (10 mL). The mixture was extracted with EtOAc (5 mL×3). The combined organic phases are washed with water and brine, dried over anhydrous Na₂SO₄, filtered and concentrated. The residue was purified by flash column chromatography on silica gel to afford compound 102. ¹H NMR (400 MHz, CDCl₃) δ 8.54-8.58 (d, J=14.4 Hz, 1H), 7.95-7.97 (d, J=8.0 Hz, 1H), 7.89 (s, 1H), 7.69-7.72 (m, 1H), 7.57-7.59 (m, 1H), 7.38-7.41 (m, 1H), 6.88-6.90 (d, J=7.2 Hz, 1H), 5.87-5.90 (br, 2H), 5.11-5.16 (d, J=16.8 Hz, 1H), 4.90-4.94 (d, J=16.4 Hz, 1H), 4.65-4.69 (m, 1H), 4.34 (s, 1H), 4.03-4.18 (m, 5H), 2.98 (s, 1H), 2.43 (s, 3H), 2.17-2.20 (m, 1H), 1.89-1.92 (m, 2H), 1.54-1.58 (m, 2H), 1.23-1.29 (m, 6H). LC/MS (ESI) m/z: 568 (M+H)⁺.

Example 34. (3-carbamoyl-1-(2-((1R,3S,4S)-3-((6-methylpyridin-2-yl)carbamoyl)-2-azabicyclo[2.2.1]heptan-2-yl)-2-oxoethyl)-1H-indol-5-yl)phosphonic acid (103)

To a solution of compound 102 in CHCl₃ (5 mL) was added TMSBr (1 mL) at 0° C. under N₂ protection. After the mixture was stirred at 50° C. for 1 h, the reaction was quenched with MeOH. The mixture was concentrated to remove the solvents and the residue was purified by prep-HPLC to afford compound 103. ¹H NMR (400 MHz, DMSO-d₆) δ 10.49 (s, 1H), 8.60 (d, J=14.3 Hz, 1H), 8.05-7.92 (m, 1H), 7.84-7.71 (m, 1H), 7.69-7.61 (m, 1H), 7.46 (dd, J=23.8, 20.2 Hz, 2H), 7.00 (dd, J=26.8, 7.4 Hz, 1H), 5.41 (d, J=17.4 Hz, 1H), 5.13 (d, J=17.2 Hz, 1H), 4.64-4.40 (m, 2H), 3.78-3.75 (m, 1H), 3.10 (d, J=4.7 Hz, 1H), 2.67 (s, 1H), 2.45-2.31 (m, 3H), 2.08 (d, J=9.3 Hz, 1H), 1.78 (s, 2H), 1.55-1.25 (m, 3H). LC/MS (ESI) m/z: 512 (M+H)⁺.

Example 35. 2-(3-carbamoyl-5-(diethoxyphosphoryl)-1H-pyrazolo[4,3-d]thiazol-1-yl)acetic acid (135)

Step 1: methyl 5-nitro-1H-pyrazole-3-carboxylate (124)

To a mixture of compound 123 (50 g, 0.318 mol) in MeOH (500 mL) was added SOCl₂ (190 g, 1.59 mol) dropwise at 0° C. The reaction was stirred at 80° C. for 6 hrs and then concentrated under reduced pressure to give the title compound (54.0 g, 98.2% yield) as white solid, which was directly used to the next reaction without further purification. LC/MS (ESI) m/z: 170 (M−H)⁻.

Step 2: methyl 1-(4-methoxybenzyl)-5-nitro-1H-pyrazole-3-carboxylate (125)

To a mixture of compound 124 (54.0 g, 0.316 mol) and K₂CO₃ (87.1 g, 0.63 mol) in DMF (400 mL) was added PMBCl (59.2 g, 0.38 mol). Then the reaction was stirred at 80° C. for 3 hrs. After cooling, the mixture was diluted with aq. LiCl (500 mL, 10%) and extracted with EtOAc (400 mL*2). The combined organic layer are washed with brine, dried over anhydrous Na₂SO₄, filtered and then concentrated. The residue was re-crystallized with PE/EtOAc (2/1) to give the title compound (40.4 g, 43.9% yield) as yellow solid.

Step 3: methyl 5-amino-1-(4-methoxybenzyl)-1H-pyrazole-3-carboxylate (126)

To a mixture of compound 125 (40.4 g, 138.8 mmol) in MeOH/THF (400 mL, 1:1) was added 10% Pd/C (4 g). The reaction was stirred at room temperature overnight under a H₂ balloon. The mixture was filtered and the filtrate was concentrated to dryness to give the title compound (33.7 g, yield 93.1%) as yellow oil, which was directly used to the next reaction without further purification. LC/MS (ESI) m/z: 262 (M+H)⁺.

Step 4: methyl 5-amino-1-(4-methoxybenzyl)-4-thiocyanato-1H-pyrazole-3-carboxylate (127)

To a mixture of compound 126 (33.7 g, 128.6 mmol) and KSCN (37.4 g, 385.9 mmol) in EtOH (300 mL) was added a solution of Br₂ (41.1 g, 257.2 mmol) in EtOH (200 mL) dropwise to maintain the internal temperature below 0° C. under N₂ atmosphere. Then the reaction was stirred at 0° C. for 16 hrs. The mixture was basified with aq. Na₂CO₃ solution to pH=9 at 0° C. and extracted with EtOAc (400 mL×2). The combined organic phases are separated, dried over anhydrous Na₂SO₄ and concentrated to dryness. The residue was re-crystallized with THF/PE (1/1) to give the title compound (23.0 g, 55.9% yield) as white solid. LC/MS (ESI) m/z: 319 (M+H)⁺.

Step 5: methyl 5-amino-1-(4-methoxybenzyl)-1H-pyrazolo[3,4-d]thiazole-3-carboxylate (128)

To a mixture of compound 127 (23.0 g, 72.1 mmol) in EtOH (160 mL) and H₂O (108 mL) was added conc. HCl (60 mL). The reaction was stirred at 90° C. for 2 hrs. After cooling, the reaction was concentrated under reduced pressure and the residue was re-crystallized with EtOAc/PE (1/2) to give the title compound (12.2 g, yield 53.1%) as white solid. LCMS: m/z 319 (M+H)⁺.

Step 6: methyl 1-(4-methoxybenzyl)-1H-pyrazolo[3,4-d]thiazole-3-carboxylate (129)

To a mixture of compound 128 (12.2 g, 38.3 mmol) and CuBr₂ (17.2 g, 76.6 mmol) in dry MeCN/THF (175 mL, 1:4) was added t-BuONO (5.92 g, 57.45 mmol) at 0° C. under N₂ atmosphere dropwise. After stirring for 1 h at 0° C., the resulting mixture was quenched with aq. Na₂S₂O₃ (150 mL, 5% wt) and extracted with DCM (80 mL×2). The combined organic phases are washed with brine, dried over anhydrous Na₂SO₄, filtered and concentrated. The residue was purified by column chromatography on silica gel (eluted with Petroleum ether: Ethyl acetate=30:1 to 5:1) to give the title compound (3.6 g, 30.9% yield) as white solid and methyl 5-bromo-1-(4-methoxybenzyl)-1H-pyrazolo[3,4-d]thiazole-3-carboxylate (4.59 g, 31.4% yield) as yellow solid.

Step 7: 1-(4-methoxybenzyl)-1H-pyrazolo[3,4-d]thiazole-3-carboxylic acid (130)

To a solution of the compound 129 (2.2 g, 7.3 mmol) in THF/H₂O (20 mL/10 mL) was added LiOH (530 mg, 22.1 mmol). The reaction was stirred at room temperature for 2 hrs. The mixture was diluted with water and washed with diethyl ether. The aqueous layer was acidified by 1N aq. HCl and extracted with DCM twice. The combined organic layers are dried over anhydrous sodium sulfate, filtered and concentrated to give the title compound (2.03 g, 94.9% yield) as white solid. LCMS: m/z 319 (M+H)⁺.

Step 8: 1-(4-methoxybenzyl)-1H-pyrazolo[3,4-d]thiazole-3-carboxamide (131)

To a solution of the compound 130 (2 g, 6.9 mmol), NH₄Cl (770 mg, 13.2 mmol) and HATU (3.04 g, 8 mmol) in DMF (30 mL) was added DIPEA (2.60 g, 20 mmol). The reaction was stirred at room temperature for 16 hrs. The mixture was diluted with EtOAc and washed with water and brine, dried over anhydrous sodium sulfate, filtered and concentrated to dryness. The residue was purified by column chromatography on silica gel (eluted with DCM:MeOH=30:1 to 10:1) to give the title compound (1.26 g, 63.3% yield) as white solid. LCMS: m/z 289 (M+H)⁺. Step 9: 1H-pyrazolo[3,4-d]thiazole-3-carboxamide (132)

A solution of compound 131 (1.2 g, 4.2 mmol) in TFA (15 mL) was stirred at room temperature for 16 hrs. The mixture was concentrated to dryness and washed with diethyl ether to give the title compound (710 mg, 100% yield) as gray solid. LCMS: m/z 169 (M+H)⁺.

Step 10: tert-butyl 2-(3-carbamoyl-1H-pyrazolo[3,4-d]thiazol-1-yl)acetate (133)

To a solution of the compound 132 (600 mg, 3.6 mmol) and tert-butyl 2-bromoacetate (1.04 g, 5.4 mmol) in DMF (15 mL) was added K₂CO₃ (1.5 g, 10.8 mmol). The reaction was stirred at room temperature for 16 hrs. The mixture was diluted with EtOAc and washed with water and brine, dried over anhydrous sodium sulfate, filtered and concentrated to dryness. The residue was purified by silica gel column (eluted with Petroleum ether: Ethyl acetate=10:1 to 1:1) to give the title compound (460 mg, 45.2% yield) as yellow solid. LCMS: m/z 283 (M+H)⁺.

Step 11: tert-butyl 2-(3-carbamoyl-5-(diethoxyphosphoryl)-1H-pyrazolo[3,4-d]thiazol-1-yl)acetate (134)

To a solution of the compound 133 (200 mg, 0.69 mmol), diethyl phosphonate (300 mg, 2.17 mmol), L-Proline (50 mg, 0.42 mmol) and K₂S₂O₈ (575 mg, 2.12 mmol) in MeCN (10 mL) was added Pd(OAc)₂ (25 mg, 0.07 mmol). The reaction was stirred at 100° C. for 16 hrs. The mixture was diluted with EtOAc and washed with water and brine, dried over anhydrous sodium sulfate, filtered, and concentrated. The residue was purified by silica gel column with (eluted with DCM:MeOH=50:1 to 20:1) to give the title compound (120 mg, 41.5% yield) as yellow solid. LCMS: m/z 419 (M+H)⁺.

Step 12: 2-(3-carbamoyl-5-(diethoxyphosphoryl)-1H-pyrazolo[3,4-d]thiazol-1-yl)acetic acid (135)

To a solution of the compound 134 (120 mg, 0.287 mmol) in DCM (3 mL) was added TFA (1 mL). The reaction was stirred at room temperature for 2 hrs. The mixture was concentrated to dryness and washed with diethyl ether to give 135 (110 mg, 100% yield) as yellow solid, which was directly used to the next reaction without purification. LCMS: m/z 363 (M+H)⁺.

Example 36. (1R,3S,5R)—N-(5′-acetyl-2′-chloro-2-fluorobiphenyl-3-yl)-2-azabicyclo[3.1.0]hexane-3-carboxamide hydrochloride

Step 1: 1-(3-bromo-4-chlorophenyl)ethanone (137)

To a solution of compound 136 (5 g, 0.032 mol) in DCE (40 mL) was added aluminum trichloride (12.9 g, 0.097 mol) in portions at 0° C., followed by dropwise addition of Br₂ (1.83 mL, 0.035 mol). After addition, the reaction was stirred at room temperature overnight. The resulting mixture was poured into ice-water and extracted with DCM twice. The combined organic layers are washed with sat. Na₂S₂O₃ and brine, dried over anhydrous Na₂SO₄, filtered and concentrated. The residue was purified by column chromatography on silica gel (eluted with Petroleum ether:Ethyl acetate=200:1) to give the title compound (5 g, 66.7% yield) as a light yellow solid.

Step 2: 2-fluoro-3-(4,4,5,5-tetramethyl-1,3,2-dioxaborolan-2-yl)aniline (139)

To a solution of compound 138 (500 mg, 2.64 mmol), 4,4,4′,4′,5,5,5′,5′-octamethyl-2,2′-bi(1,3,2-dioxaborolane) (806 mg, 3.17 mmol) and KOAc (518 mg, 5.29 mmol) in DMF (10 mL) was added Pd(dppf)Cl₂ (108 mg, 0.13 mmol) at room temperature under N₂ atmosphere. The reaction was stirred under nitrogen protection at 100° C. for 16 hrs. Water (10 mL) was added and the mixture was extracted with ethyl acetate (20 mL×2). The combined organic phases are washed with brine, dried over anhydrous Na₂SO₄, filtered and then concentrated. The residue was purified by column chromatography on silica gel (eluted with Petroleum ether:Ethyl acetate=40:1) to give the title compound (380 mg, 60.7% yield) as white solid. LC/MS (ESI) m/z: 238 (M+H)⁺.

Step 3: 1-(3′-amino-6-chloro-2′-fluorobiphenyl-3-yl)ethanone (140)

To a solution of compound 137 (600 mg, 2.58 mmol), compound 139 (732 mg, 3.12 mmol) and Na₂CO₃ (822 mg, 7.74 mmol) in dioxane/H₂O (10 mL/3 mL) at room temperature under nitrogen, was added Pd(PPh₃)₄ (50 mg, 0.043 mmol). The reaction was stirred under nitrogen protection at 100° C. for 16 hrs. The resulting mixture was concentrated and the residue was purified by column chromatography on silica gel (eluted with Petroleum ether:Ethyl acetate=10:1) to give the title compound (510 mg, 75.05% yield) as white solid. LC/MS (ESI) m/z: 264 (M+H)⁺.

Step 4: (1R,3S,5R)-tert-butyl 3-((5′-acetyl-2′-chloro-2-fluoro-[1,1′-biphenyl]-3-yl)carbamoyl)-2-azabicyclo[3.1.0]hexane-2-carboxylate (141)

To a solution of (1R,3S,5R)-2-(tert-butoxycarbonyl)-2-azabicyclo[3.1.0]hexane-3-carboxylic acid (400 mg, 1.76 mmol) in DMF (5 mL) was added DIPEA (0.87 mL, 5.28 mmol) and HATU (1.00 g, 2.64 mmol) at 0° C. The mixture was stirred at room temperature for 10 min and then compound 140 (463 mg, 1.76 mmol) was added. The reaction was stirred at room temperature overnight and then quenched with diluted with water (10 mL). The resulting mixture was extracted with ethyl acetate (10 mL×3). The combined organic phases are washed with water and brine, dried over anhydrous Na₂SO₄, filtered and concentrated. The residue was purified by column chromatography on silica gel (eluted with DCM/MeOH=30:1) to give the title compound (370 mg, 44.5% yield) as white solid. LC/MS (ESI) m/z: 473 (M+H)⁺

Step 5: (1R,3S,5R)—N-(5′-acetyl-2′-chloro-2-fluorobiphenyl-3-yl)-2-azabicyclo[3.1.0]hexane-3-car-boxamide hydrochloride (142)

A solution of compound 141 (300 mg, 0.64 mmol) in HCl/dioxane solution (15 mL, 1M) was stirred at room temperature for 1 hr. The mixture was concentrated and the residue was washed with diethyl ether to give 141 (250 mg, 80.2% yield) as a white solid, which was used in the next step without purification. LC/MS (ESI) m/z: 373 (M+H)⁺.

Example 37. (2S,4R)-4-fluoro-N-(6-methylpyridin-2-yl)pyrrolidine-2-carboxamide hydrochloride (144)

Step 1: (2S,4R)-tert-butyl 4-fluoro-2-(6-methylpyridin-2-ylcarbamoyl)pyrrolidine-1-carboxylate (143)

To a mixture of compound 34 (7.0 g, 0.03 mol) in DCE (60 mL) was added ethyl 2-ethoxyquinoline-1(2H)-carboxylate (14.84 g, 0.06 mol), N, N′-diisopropylethylamine (11.63 g, 0.09 mol) and 6-methylpyridin-2-amine (3.24 g, 0.03 mol), then the reaction was stirred at 90° C. under N₂ atmosphere overnight. The mixture was cooled, quenched with water and extracted with DCM twice. The combined organic layers are washed with brine, dried over anhydrous Na₂SO₄ and concentrated. The residue was purified by column chromatography on silica gel (eluted with PE/EtOAc=30:1 to 2:1) to give the title compound (9.50 g, 97.9% yield) as white solid. LC/MS (ESI) m/z: 324 (M+H)⁺.

Step 2: (2S,4R)-tert-butyl 4-fluoro-2-(6-methylpyridin-2-ylcarbamoyl)pyrrolidine-1-carboxylate TFA salt (144)

A mixture of compound 143 (1 g, 3.09 mol) in HCl/dioxane solution (10 mL, 2M) was stirred at room temperature for 2 hrs. The mixture was concentrated and the residue was washed with Et₂O to give the title compound 144 (760 mg, 94.7% yield) as yellow solid. LC/MS (ESI) m/z: 224 (M+H)⁺.

Example 38. diethyl (1-(2-((1R,3S,5R)-3-((5′-acetyl-2′-chloro-2-fluoro-[1,1′-biphenyl]-3-yl)carbamoyl)-2-azabicyclo[3.1.0]hexan-2-yl)-2-oxoethyl)-3-carbamoyl-1H-pyrazolo[3,4-d]thiazol-5-yl)phosphonate (145)

To a solution of 2-(3-carbamoyl-5-(diethoxyphosphoryl)-1H-pyrazolo[3,4-d]thiazol-1-yl)acetic acid (60 mg, 0.17 mmol) in DMF (5 ml) was added DIPEA (0.08 ml, 0.49 mmol), HATU (94 mg, 0.25 mmol) and (1R,3S,5R)—N-(5′-acetyl-2′-chloro-2-fluoro-[1,1′-biphenyl]-3-yl)-2-azabicyclo[3.1.0]hexane-3-carboxamide (62 mg, 0.17 mmol). The reaction was stirred at room temperature overnight and then diluted with water (10 mL). The resulting mixture was extracted with EtOAc (10 mL×3). The combined organic phases are washed with water and brine, dried over anhydrous Na₂SO₄, filtered and concentrated. The residue was purified by column chromatography on silica gel (eluted with DCM:MeOH=30:1˜15:1) to give the titled product (80 mg, yield 66%) as a white solid. ¹HNMR (400 MHz, CDCl₃) δ 8.97 (s, 1H), 8.34 (t, J=7.1 Hz, 1H), 7.91 (dd, J=8.3, 2.2 Hz, 1H), 7.86 (d, J=2.1 Hz, 1H), 7.57 (d, J=8.3 Hz, 1H), 7.21 (t, J=7.9 Hz, 1H), 7.10-6.96 (m, 1H), 6.66 (s, 1H), 5.60-5.46 (m, 2H), 5.39 (s, 1H), 4.84 (dd, J=8.5, 2.6 Hz, 1H), 4.41-4.09 (m, 4H), 3.40-3.31 (m, 1H), 3.11-2.97 (m, 1H), 2.60 (s, 3H), 2.07 (dd, J=14.2, 9.7 Hz, 2H), 1.34 (td, J=7.0, 2.0 Hz, 6H), 0.87 (d, J=7.0 Hz, 1H), 0.79 (td, J=5.2, 2.4 Hz, 1H). LC/MS (ESI) m/z: 717 (M+H)⁺.

Example 39. diethyl (3-carbamoyl-1-(2-((2S,4R)-4-fluoro-2-((6-methylpyridin-2-yl)carbamoyl)pyrrolidin-1-yl)-2-oxoethyl)-1H-pyrazolo[4,3-d]thiazol-5-yl)phosphonate (146)

The titled compound was prepared according the procedure for example 38. ¹H NMR (400 MHz, CD₃OD) δ 7.83 (d, J=8.3 Hz, 1H), 7.64 (dt, J=33.8, 7.9 Hz, 1H), 6.96 (d, J=7.5 Hz, 1H), 5.66 (d, J=17.0 Hz, 1H), 5.52 (d, J=16.9 Hz, 1H), 5.41 (s, 1H), 4.76 (t, J=8.5 Hz, 1H), 4.36-4.15 (m, 4H), 4.11-3.90 (m, 1H), 3.61 (q, J=7.4 Hz, 1H), 2.70 (s, 1H), 2.43 (d, J=19.6 Hz, 3H), 2.34-2.19 (m, 1H), 1.39-1.31 (m, 6H). LC/MS (ESI) m/z: 568 (M+H)⁺.

Example 40. (3-carbamoyl-1-(2-((2S,4R)-4-fluoro-2-((6-methylpyridin-2-yl)carbamoyl)pyrrolidin-1-yl)-2-oxoethyl)-1H-pyrazolo[3,4-d]thiazol-5-yl)phosphonic acid (147)

The titled compound was prepared according the procedure for example 34. ¹H NMR (400 MHz, CD₃OD) δ 7.81 (d, J=8.3 Hz, 1H), 7.67 (t, J=7.9 Hz, 1H), 7.02 (dd, J=23.7, 7.6 Hz, 1H), 5.70-5.33 (m, 3H), 4.75 (s, 1H), 4.32-4.12 (m, 1H), 3.94 (dd, J=36.7, 12.1 Hz, 1H), 2.68 (s, 1H), 2.45 (d, J=15.8 Hz, 3H), 2.27 (d, J=39.4 Hz, 1H). LC/MS (ESI) m/z: 512 (M+H)⁺.

Example 41. (2S,4R)-4-fluoro-N-(3-(thieno[3,2-b]thiophen-2-yl)cyclopentyl)pyrrolidine-2-carbothioamide hydrochloride (159)

Step 1: 4,4,5,5-tetramethyl-2-(thieno[3,2-b]thiophen-2-yl)-1,3,2-dioxaborolane (149)

To a solution of 148 (5 g, 35.65 mmol) in THF (70 mL) was added n-BuLi (1.6 M in hexanes, 23.4 mL, 37.4 mmol) at −70° C. dropwise for 30 min with stirring under N₂ atmosphere. After addition, the reaction was stirred at the same temperature for 30 min, followed by the addition of 2-isopropoxy-4,4,5,5-tetramethyl-1,3,2-dioxaborolane (7.29 g, 39.2 mmol). The reaction was allowed to warm to room temperature and stirred for 16 hrs. After quenched with saturated aq. NH₄Cl solution at 0° C., the mixture was extracted with EtOAc twice. The combined organic layers are washed with brine, dried over anhydrous Na₂SO₄ and concentrated to dryness to give the title compound (8.1 g, 85.4% yield) as light green solid.

Step 2: 2-(3-oxocyclopentyl)isoindoline-1,3-dione (151)

To a slurry of cyclopentenone (5 g, 60.9 mmol) and phthalimide (9 g, 61.1 mol) in MeOH (440 mL) was added aqueous Na₂CO₃ solution (2 M, 4 mL, 8 mmol) dropwise at 0° C. for 30 min. The reaction was stirred at room temperature for 16 hrs. After filtration, the filter cake was washed with cooled MeOH, dried under vacuum to give the title compound (6.8 g, 48.7% yield) as white solid. LC/MS (ESI) m/z: 230 [M+H]⁺.

Step 3: 3-(1,3-dioxoisoindolin-2-yl)cyclopent-1-enyl trifluoromethanesulfonate (152)

To a mixture of DIPEA (5.32 g, 41.17 mmol) and 151 (5.9 g, 25.73 mmol) in DCM (100 mL) was dropwise added Tf₂O (8.7 g, 30.9 mmol) at 0° C. for 30 min. The reaction was stirred at 0° C. for 16 hrs. After diluted with DCM, the mixture was washed with aq. NH₄Cl solution and aq. NaHCO₃ solution successively. The organic phase was dried over anhydrous Na₂SO₄, filtered and concentrated to give crude product, which was purified by column chromatography on silica gel (eluted with petroleum ether:ethyl acetate=4:1) to give the title compound (6.3 g, 67.7% yield) as off-white solid.

Step 4: 2-(3-(thieno[3,2-b]thiophen-2-yl)cyclopent-2-enyl)isoindoline-1,3-dione (154)

To a mixture of 152 (6.3 g, 17.4 mmol) and 153 (4.8 g, 17.4 mmol) in DME/water (100 mL/30 mL) was added CsF (3.96 g, 26.1 mmol). The mixture was degassed under N₂ for three times and then Pd(PPh₃)₄ was added in one portion under N₂ atmosphere. The resulting mixture was degassed again and stirred at 70° C. under N₂ atmosphere for 16 hrs. After cooled to room temperature, the mixture was filtered. The filter cake was washed with water and cooled ethanol, dried under vacuum to give the title compound (5.9 g, 96.4% yield) as pale solid. LC/MS (ESI) m/z: 352 [M+H]⁺.

Step 5: 3-(thieno[3,2-b]thiophen-2-yl)cyclopent-2-enamine (155)

To a slurry of 155 (5.9 g, 16.78 mmol) in EtOH (100 mL) was added hydrazine hydrate (4.94 g, 83.9 mmol, 85%) and The reaction was stirred at reflux for 2 hrs. The mixture was cooled to 0° C. and diluted with EtOH (50 mL) and filtered. The filter cake was washed with cooled EtOH and the filtrate was concentrated to dryness to give crude product, which was purified by column chromatography on silica gel (eluted with DCM:MeOH=20:1) to give 7 (3.3 g, 88.85% yield) as yellow solid. LC/MS (ESI) m/z: 222 [M+H]⁺.

Step 6: 3-(thieno[3,2-b]thiophen-2-yl)cyclopentanamine (156)

To a solution of 155 (3 g, 13.55 mmol) in EtOH (50 mL) was added conc. HCl (3 mL), The mixture was degassed under N₂ atmosphere for three times and Pd/C (300 mg, 10%) was added. The resulting mixture was degassed under N₂ atmosphere and stirred under H₂ balloon at 45° C. for 32 hrs. After filtration, the filter cake was washed with EtOH twice. The combined filtrates are concentrated to dryness to give the title compound (2.3 g, 75.99% yield) as foam-like solid. LC/MS (ESI) m/z: 224 [M+H]⁺.

Step 7: (2S,4R)-tert-butyl 4-fluoro-2-(3-(thieno[3,2-b]thiophen-2-yl)cyclopentylcarbamoyl)pyrrolidine-1-carboxylate (157)

To a mixture of 156 (500 mg, 2.24 mmol) and (2S,4R)-1-(tert-butoxycarbonyl)-4-fluoropyrrolidine-2-carboxylic acid (522 mg, 2.24 mmol) in DMF (10 mL) was added HATU (1.1 g, 2.91 mmol) followed by DIPEA (434 mg, 3.36 mmol) at 0° C. The reaction was stirred at room temperature for 16 hrs. After diluted with EtOAc, the mixture was washed with 10% aq. LiCl solution. The organic phase was dried over anhydrous Na₂SO₄, filtered and concentrated to give crude product, which was purified by column chromatography on silica gel (eluted with DCM:MeOH=40:1) to give the title compound (580 mg, 59.04% yield) as light yellow solid. LC/MS (ESI) m/z: 383 [M+H-56]+.

Step 8: (2S,4R)-tert-butyl 4-fluoro-2-((3-(thieno[3,2-b]thiophen-2-yl)cyclopentyl)carbamothioyl)pyrrolidine-1-carboxylate (158)

To a solution of compound 157 (440 mg, 1 mmol) in toluene (6 mL) and was added Lawesson's Reagent (202 mg, 0.5 mmol) at 0° C. The reaction was heated at 80° C. for 16 hrs and concentrated to dryness. The residue was purified by silica gel chromatography with (petroleum ether:ethyl acetate=5:1) to give the title compound (220 mg, 48.5% yield) as yellow solid. LC/MS (ESI) m/z: 455 [M+1]⁺.

Step 9: (2S,4R)-4-fluoro-N-(3-(thieno[3,2-b]thiophen-2-yl)cyclopentyl)pyrrolidine-2-carbothioamide hydrochloride (159)

A mixture of compound 158 (220 mg, 0.48 mmol) and HCl/1.4-dioxane (15 mL, 1M) was stirred at room temperature for 3 hrs. The reaction was concentrated under high vacuum. The residue was washed with diethyl ether, dried under vacuum to give 159 (170 mg, 90.6% yield) as yellow solid, which was directly used to the next reaction without purification. LC/MS (ESI) m/z: 355 [M+1]⁺.

Example 42. diethyl (3-carbamoyl-1-(2-((2S,4R)-4-fluoro-2-((3-(thieno[3,2-b]thiophen-2-yl)cyclopentyl)carbamothioyl)pyrrolidin-1-yl)-2-oxoethyl)-1H-pyrazolo[3,4-d]thiazol-5-yl)phosphonate (160)

The titled compound was prepared according to the procedure forexample 38. ¹H NMR (400 MHz, DMSO-d₆) δ 10.28 (d, J=7.4 Hz, 1H), 7.96 (d, J=16.6 Hz, 1H), 7.67 (s, 1H), 7.59-7.50 (m, 1H), 7.35 (q, J=4.7 Hz, 1H), 7.27-7.11 (m, 1H), 5.72 (d, J=17.4 Hz, 1H), 5.53 (d, J=49.1 Hz, 1H), 5.36 (dd, J=17.4, 7.1 Hz, 1H), 5.21-4.91 (m, 1H), 4.84 (t, J=8.0 Hz, 1H), 4.71-4.54 (m, 1H), 4.20 (dddd, J=13.5, 10.1, 8.1, 6.4 Hz, 4H), 4.10-3.83 (m, 1H), 2.84-2.56 (m, 1H), 2.36-1.94 (m, 4H), 1.89-1.58 (m, 3H), 1.34-1.18 (m, 6H). LC/MS (ESI) m/z: 699 (M+H)⁺.

Example 43. Non-Limiting Examples of Compounds of Formula I

Table 1 shows illustrative compounds of Formula I with characaterizing data. The assay of Example 25 was used to determine the IC₅₀'s of the compounds. Other standard factor D inhibition assays are also available. Three ***s are used to denote compounds with an IC₅₀ less than 1 micromolar; two **s indicate compound with an IC₅₀ between 1 micromolar and 10 micromolar, and one * denotes compounds with an IC₅₀ greater than 10 micromolar.

TABLE 1 Cmp RT min MS No. Structure Name IC₅₀ (Method A or B) (M + 1) 1

diethyl 3-acetyl-1-(2- ((2S,4R)-2-(3-chloro-2- fluorobenzylcarbamoyl)-4- fluoropyrrolidin-1-yl)-2- oxoethyl)-1H-indol-6- ylphosphonate *** 1.83 (A) 610 2

ethyl hydrogen 3-acetyl-1- (2-((2S,4R)-2-(3-chloro-2- fluorobenzylcarbamoyl)-4- fluoropyrrolidin-1-yl)-2- oxoethyl)-1H-indol-6- ylphosphonate *** 1.20 (A) 582 3

3-acctyl-1-(2-((2S,4R)-2- (3-chloro-2- fluorobenzylcarbamoyl)-4- fluoropyrrolidin-1-yl)-2- oxoethyl)-1H-indol-6- ylphosphonic acid *** 1.06 (A) 554 4

((3-acetyl-1-(2-((2S,4R)-2- (3-chloro-2- fluorobenzylcarbamoyl)-4- fluoropyrrolidin-1-yl)-2- oxoethyl)-1H-indol-6- yl)phosphoryl)bis(oxy) bis(methylene) isopropyl dicarbonate *** 2.31 (A) 786 5

diethyl 3-acetyl-1-(2- ((2S,3aR,6aR)-2-(3-chloro- 2-fluorobenzylcarbamoyl) hexahydrocyclopenta[b] pyrrol-1(2H)-yl)-2-oxoethyl)- 1H-indol-6-ylphosphonate ** 2.13 (A) 632 6

((3-acetyl-1-(2-((2S,4R)-2- (3-chloro-2- fluorobenzylcarbamoyl)-4- fluoropyrrolidin-1-yl)-2- oxoethyl)-1H-indol-6- yl)(ethoxy)phosphoryloxy) methyl isopropyl carbonate *** 2.08 (A) 698 7

3-acetyl-1-(2- ((2S,3aR,6aR)-2-(3-chloro- 2-fluorobenzylcarbamoyl) hexahydrocyclopenta [b]pyrrol-1(2H)-yl)-2- oxoethyl)-1H-indol-6- ylphosphonic acid *** 1.44 (A) 576 8

diethyl 3-acetyl-1-(2- ((2S,4R)-2-(3-chloro-2- fluorobenzylcarbamoyl)-4- fluoropyrrolidin-1-yl)-2- oxoethyl)-1H-indol-5- ylphosphonate *** 1.74 (A) 610 9

ethyl hydrogen 3-acetyl-1- (2-((2S,4R)-2-(3-chloro-2- fluorobenzylcarbamoyl)-4- fluoropyrrolidin-1-yl)-2- oxoethyl)-1H-indol-5- ylphosphonate * 1.19 (A) 582 10

3-acetyl-1-(2-((2S,4R)-2- (3-chloro-2- fluorobenzylcarbamoyl)-4- fluoropyrrolidin-1-yl)-2- oxoethyl)-1H-indol-5- ylphosphonic acid *** 1.04 (A) 554 11

ethyl 1-(2-((2S,4R)-2- (3-chloro-2- fluorobenzylcarbamoyl)- 4-fluoropyrrolidin-1-yl)- 2-oxoethyl)-6- (diethoxyphosphoryl)-1H- indazole-3-carboxylate * 2.15 (A) 641 12

1-(2-((2S,4R)-2-(3-chloro- 2-fluorobenzylcarbamoyl)- 4-fluoropyrrolidin-1-yl)- 2-oxoethyl)-6- (diethoxyphosphoryl)-1H- indazole-3-carboxylic acid * 1.65 (A) 613 13

methyl 1-(2-((2S,4R)-2- (3-chloro-2- fluorobenzylcarbamoyl)- 4-fluoropyrrolidin-1-yl)- 2-oxoethyl)-6- (diethoxyphosphoryl)-1H- indole-3-carboxylate *** 2.03 (A) 626 14

1-(2-((2S,4R)-2-(3-chloro- 2-fluorobenzylcarbamoyl)- 4-fluoropyrrolidin-1-yl)- 2-oxoethyl)-3- (methoxycarbonyl)-1H- indol-6-ylphosphonic acid *** 1.22 (A) 570 15

diethyl 3-carbamoyl-1-(2- ((2S,4R)-2-(3-chloro-2- fluorobenzylcarbamoyl)-4- fluoropyrrolidin-1-yl)-2- oxoethyl)-1H-indol-6- ylphosphonate *** 1.54 (A) 611 16

3-carbamoyl-1-(2-((2S,4R)- 2-(3-chloro-2- fluorobenzylcarbamoyl)-4- fluoropyrrolidin-1-yl)-2- oxoethyl)-1H-indol-6- ylphosphonic acid *** 0.72 (A) 555 17

diethyl 3-carbamoyl-1-(2- ((2S,4R)-2-(3-chloro-2- fluorobenzylcarbamoyl)-4- fluoropyrrolidin-1-yl)-2- oxoethyl)-1H-indazol-6- ylphosphonate *** 1.59 (A) 612 18

3-carbamoyl-1-(2-((2S,4R)- 2-(3-chloro-2- fluorobenzylcarbamoyl)-4- fluoropyrrolidin-1-yl)-2- oxoethyl)-1H-indazol-6- ylphosphonic acid *** 0.70 (A) 556 19

bis(2,2,2-trifluoroethyl) 3- acetyl-1-(2-((2S,4R)-2- (3-chloro-2- fluorobenzylcarbamoyl)- 4-fluoropyrrolidin-1-yl)- 2-oxoethyl)-1H-indol- 6-ylphosphonate *** 2.26 (A) 718 20

dibutyl 3-acetyl-1-(2- ((2S,4R)-2-(3-chloro-2- fluorobenzylcarbamoyl)- 4-fluoropyrrolidin-1-yl)- 2-oxoethyl)-1H-indol-6- ylphosphonate *** 2.47 (A) 666 21

butyl hydrogen 3-acetyl-1- (2-((2S,4R)-2-(3-chloro-2- fluorobenzylcarbamoyl)-4- fluoropyrrolidin-1-yl)-2- oxoethyl)-1H-indol-6- ylphosphonate *** 1.49 (A) 610 22

((3-acetyl-1-(2-((2S,4R)-2- (3-chloro-2- fluorobenzylcarbamoyl)- 4-fluoropyrrolidin-1-yl)- 2-oxoethyl)-1H-indol-6- yl)(hydroxy)phosphoryloxy) methyl isopropyl carbonate *** 1.34 (A) 670 23

ethyl 3-acetyl-1-(2- ((2S,4R)-2-(3-chloro-2- fluorobenzylcarbamoyl)-4- fluoropyrrolidin-1-yl)-2- oxoethyl)-1H-indol-6- yl(phenyl)phosphinate *** 1.97 (A) 642 24

ethyl 3-acetyl-1-(2- ((2S,4R)-2-(3-chloro-2- fluorobenzylcarbamoyl)-4- fluoropyrrolidin-1-yl)-2- oxoethyl)-1H-indol-6- yl(ethyl)phosphinate *** 1.64 (A) 594 25

3-acetyl-1-(2-((2S,4R)-2- (3-chloro-2- fluorobenzylcarbamoyl)-4- fluoropyrrolidin-1-yl)-2- oxoethyl)-1H-indol-6- yl(phenyl)phosphinic acid *** 1.49 (A) 614 26

((3-acetyl-1-(2-((2S,4R)- 2-(3-chloro-2- fluorobenzylcarbamoyl)-4- fluoropyrrolidin-1-yl)-2- oxoethyl)-1H-indol-6- yl)phosphoryl)bis(oxy)bis (methylene) bis(2,2- dimethylpropanoate) *** 2.41 (A) 782 27

3-acetyl-1-(2-((2S,4R)-2- (3-chloro-2- fluorobenzylcarbamoyl)-4- fluoropyrrolidin-1-yl)-2- oxoethyl)-1H-indol-6- yl(ethyl)phosphinic acid *** 1.24 (A) 566 28

((3-acetyl-1-(2-((2S,4R)-2- (3-chloro-2- fluorobenzylcarbamoyl)-4- fluoropyrrolidin-1-yl)-2- oxoethyl)-1H-indol-6- yl)(hydroxy)phosphoryloxy) methyl pivalate *** 1.14 (A) 668 29

2,2,2-trifluoroethyl hydrogen 3-acetyl-1-(2- ((2S,4R)-2-(3-chloro-2- fluorobenzylcarbamoyl)-4- fluoropyrrolidin-1-yl)-2- oxoethyl)-1H-indol-6- ylphosphonate *** 1.08 (A) 636 30

diethyl 3-acetyl-1-(2- ((2S,4R)-2-(3-chloro-2- fluorobenzylcarbamoyl)-4- fluoropyrrolidin-1-yl)-2- oxoethyl)-5-fluoro-1H- indol-6-ylphosphonate *** 1.41 (A) 628 31

3-acetyl-1-(2-((2S,4R)-2- (3-chloro-2- fluorobenzylcarbamoyl)- 4-fluoropyrrolidin-1-yl)- 2-oxoethyl)-5-fluoro-1H- indol-6-ylphosphonic acid *** 0.93 (A) 572 32

1-(2-((2S,4R)-2-(3-chloro- 2-fluorobenzylcarbamoyl)- 4-fluoropyrrolidin-1-yl)-2- oxoethyl)-3-(2,2,2- trifluoroacetyl)-1H-indol-6- ylphosphonic acid *** 1.54 (A) 608 33

diphenyl 3-acetyl-1-(2- ((2S,4R)-2-(3-chloro-2- fluorobenzylcarbamoyl)-4- fluoropyrrolidin-1-yl)-2- oxoethyl)-1H-indol-6- ylphosphonate *** 2.44 (A) 707

Table 2 shows illustrative compounds of Formula I where Z³² equals R³².

TABLE 2 Additional Non-limiting Examples of Compounds of Formula 1 Comp. No. Structure 2-1

2-2

2-3

2-4

2-5

2-6

2-7

2-8

2-9

 2-10

Table 3 shows illustrative compounds of Formula I with characaterizing data. The assay of Example 25 was used to determine the IC₅₀'s of the compounds. Other standard factor D inhibition assays are also available. Three ***s are used to denote compounds with an IC₅₀ less than 1 micromolar; two **s indicate compound with an IC₅₀ between 1 micromolar and 10 micromolar, and one * denotes compounds with an IC₅₀ greater than 10 micromolar

TABLE 3 Additional Non-limiting Examples of Compounds of Formula 1 RT min Cmp IC₅₀ (Method MS No. Structure Name (Stars) A,B,C or D) (M + 1) 74

diethyl (3-acetyl-1-(2- ((2S,4R)-2- (benzylcarbamoyl)-4- fluoropyrrolidin-1-yl)- 2-oxoethyl)-1H-indol- 5-yl)phosphonate * 9.53 (D) 558 78

diethyl (3-acetyl-1-(2- ((2S,4R)-4-fluoro-2- (phenethylcarbamoyl) pyrrolidin-1-yl)-2- oxoethyl)-1H-indol-5- yl)phosphonate * 11.62 (C)  572 82

diethyl (3-acetyl-1-(2- ((2S,4R)-4-fluoro-2- ((3-phenylpropyl) carbamoyl)pyrrolidin-1- yl)-2-oxoethyl)-1H-indol- 5-yl)phosphonate * 9.40 (D) 586 83

(3-acetyl-1-(2- ((2S,4R)-4-fluoro-2- ((3-phenylpropyl) carbamoyl)pyrrolidin-1- yl)-2-oxoethyl)-1H-indol- 5-yl)phosphonic acid * 7.16 (D) 530 79

(3-acetyl-1-(2- ((2S,4R)-4-fluoro-2- (phenethylcarbamoyl) pyrrolidin-1-yl)-2- oxoethyl)-1H-indol-5- yl)phosphonic acid * 9.30 (C)  514 (M − 1) 74

(3-acetyl-1-(2-((2S,4R)- 2-(benzylcarbamoyl)-4- fluoropyrrolidin-1-yl)- 2-oxoethyl)-1H-indol- 5-yl)phosphonic acid * 6.10 (D) 502 86

diethyl (3-acetyl-1-(2- ((2S,4R)-4-fluoro-2- ((4-phenylbutyl) carbamoyl)pyrrolidin- 1-yl)-2-oxoethyl)-1H- indol-5-yl)phosphonate * 10.85 (D)  600 87

(3-acetyl-1-(2- ((2S,4R)-4-fluoro-2- ((4-phenylbutyl) carbamoyl)pyrrolidin- 1-yl)-2-oxoethyl)-1H- indol-5-yl)phosphonic acid * 7.71 (D) 544 100

(S)-diethyl (3-acetyl- 1-(2-(2-((6- methylpyridin-2- yl)carbamoyl)azetidin- 1-yl)-2-oxoethyl)-1H- indol-5-yl)phosphonate * 9.34 (D) 527 95

diethyl (3-acetyl-1-(2- ((2R,4R)-4-fluoro-2-(2- (phenylsulfonamido) ethyl)pyrrolidin-1-yl)-2- oxoethyl)-1H-indol-5- yl)phosphonate * 10.20 (D)  608 101

(S)-(3-acetyl-1-(2-(2- ((6-methylpyridin-2- yl)carbamoyl)azetidin- 1-yl)-2-oxoethyl)-1H- indol-5-yl)phosphonic acid * 6.12 (D) 471 102

diethyl (3-carbamoyl-1- (2-((1R,3S,4S)-3- ((6-methylpyridin-2- yl)carbamoyl)-2- azabicyclo[2.2.1]heptan- 2-yl)-2-oxoethyl)-1H-indol- 5-yl)phosphonate * 3.32 (B) 568 103

(3-carbamoyl-1-(2- ((1R,3S,4S)-3-((6- methylpyridin-2-yl) carbamoyl)-2- azabicyclo[2.2.1]heptan- 2-yl)-2-oxoethyl)-1H- indol-5-yl)phosphonic acid * 2.12 (B) 512 96

(3-acetyl-1-(2- ((2R,4R)-4-fIuoro-2-(2- (phenylsulfonamido) ethyl)pyrrolidin-1-yl)-2- oxoethyl)-1H-indol-5- yl)phosphonic acid * 6.84 (D) 552 104

diethyl (1-(2- ((1R,3S,5R)-3-((5′- acetyl-2′-chloro-2- fIuoro-[1,1′-biphenyl]- 3-yl)carbamoyl)-2- azabicyclo[3.1.0]hexan- 2-yl)-2-oxoethyl)-3- carbamoyl-1H- pyrazolo[3,4-d]thiazol- 5-yl)phosphonate *** 3.32 (B) 717 105

(3-acetyl-1-(2-((2S,4R)- 2-((6-bromopyridin-2- yl)carbamoyl)-4- fluoropyrrolidin-1-yl)- 2-oxoethyl)-1H-indazol- 6-yl)phosphonic acid *** 7.03 (D)  567 (M − 1) 106

(3-acetyl-1-(2- ((1R,3S,5R)-3-((6- bromopyridin-2-yl) carbamoyl)-5-methyl-2- azabicyclo[3.1.0]hexan- 2-yl)-2-oxoethyl)-1H- indazol-6-yl) phosphonic acid *** 11.18 (C)   575 (M − 1) 145

diethyl (1-(2- ((1R,3S,5R)-3-((5′- acetyl-2′-chloro-2- fluoro-[1,1′-biphenyl]- 3-yl)carbamoyl)-2- azabicyclo[3.1.0]hexan- 2-yl)-2-oxoethyl)-3- carbamoyl-1H- pyrazolo[3,4-d]thiazol- 5-yl)phosphonate *** 3.32 (B) 717 146

diethyl (3-carbamoyl-1- (2-((2S,4R)-4-fluoro-2- ((6-methylpyridin-2- yl)carbamoyl)pyrrolidin- 1-yl)-2-oxoethyl)-1H- pyrazolo[4,3-d]thiazol- 5-yl)phosphonate * 1.93 (B) 568 147

(3-carbamoyl-1-(2- ((2S,4R)-4-fluoro-2- ((6-methylpyridin-2- yl)carbamoyl)pyrrolidin- 1-yl)-2-oxoethyl)-1H- pyrazolo[4,3-d]thiazol- 5-yl)phosphonic acid * 0.51 (B) 512 148

diethyl (3-carbamoyl-1- (2-((2S,4R)-4-fluoro-2- ((3-(thieno[3,2-b]thiophen- 2-yl)cyclopentyl)carbamo thioyl)pyrrolidin-1-yl)- 2-oxoethyl)-1H-thieno [3,2-c]pyrazol-5-yl) phosphonate * 3.87 (B) 699

Example 44. Human Factor D Assay

Human Factor D (purified from human serum, Complement Technology, Inc.) at 80 nM final concentration was incubated with test compound at various concentrations for 5 minutes at room temperature in 50 mM Tris, 1M NaCl, pH 7.5. A synthetic substrate Z-L-Lys-SBzl and DTNB (Ellman's reagent) are added to final concentrations of 100 M each. Absorbance at 405 nm (A₄₀₅) was recorded at 30 second intervals for 30 minutes using a microplate spectrophotometer. IC₅₀ values are calculated by nonlinear regression of complement Factor D reaction rates as a function of test compound concentration.

Example 45. Hemolysis Assay

The hemolysis assay was previously described by G. Ruiz-Gomez, et al., J. Med. Chem. (2009) 52: 6042-6052. Prior to the assay, the optimum concentration of Normal Human Serum (NHS) needed to achieve 100% lysis of rabbit erythrocytes (RE) was determined by titration. In the assay, NHS (Complement Technology) was diluted in GVB⁰ Buffer (0.1% gelatin, 5 mM Veronal, 145 mM NaCl, 0.025% NaN₃, pH 7.3, Complement Technology) plus 10 mM Mg-EGTA and incubated with test compound at various concentrations for 15 minutes at 37° C. RE (Complement Technology) freshly suspended in GVB⁰ plus 10 mM Mg-EGTA are added to a final concentration of 1×10⁸ cells/mL and reactions are incubated for 30 minutes at 37° C. Positive control reactions (100% lysis) consist of GVB⁰ plus 10 mM Mg-EGTA with NHS and RE but without test compound; negative control reactions (0% lysis) consist of GVB⁰ plus 10 mM Mg-EGTA with RE only. Samples are centrifuged at 2000 g for 3 minutes and supernatants collected. Absorbance at 405 nm (A₄₀₅) was recorded using a microplate spectrophotometer. IC₅₀ values are calculated by nonlinear regression from the percentage of hemolysis as a function of test compound concentration.

Example 46. Effect of Combination Therapy

The combinatorial efficacy of two compounds on the complement alternative pathway (CAP) was assessed by determining the effect of two compounds mixed together at various concentrations with Normal Human Serum (NHS) on the hemolysis of rabbit erythrocytes (RE) or the production of terminal complement complex (TCC). In both assays the two test compounds are prepared individually in seven-point dilution series, with an eighth sample for each containing solvent alone, and each of the 64 possible combinations was tested in duplicate or triplicate wells.

In the hemolysis assay, NHS (Complement Technology) diluted to 10% in GVB⁰ Buffer (0.1% gelatin, 5 mM Veronal, 145 mM NaCl, 0.025% NaN₃, pH 7.3, Complement Technology) plus 10 mM Mg-EGTA was incubated with the compounds at various concentrations for 15 minutes at 37° C. RE (Complement Technology) freshly suspended in GVB⁰ plus 10 mM Mg-EGTA are added to a final concentration of 1×10⁸ cells/mL and reactions are incubated for 30 minutes at 37° C. Positive control reactions consist of GVB⁰ plus Mg-EGTA with NHS and RE but without test compounds; negative control reactions consist of GVB⁰ plus Mg-EGTA with RE only. Samples are centrifuged at 2000 g for 3 minutes and supernatants collected. Absorbance at 405 nM (A₄₀₅) was recorded using a microplate spectrophotometer.

The assay for TCC production was conducted using the Complement system Alternative Pathway Wieslab assay kit (Euro Diagnostica). NHS diluted to 5.56% in the provided diluent was incubated with each compound in the wells of the provided assay plates for 60 minutes at 37° C. The wells are emptied and washed with the provided wash solution, incubated with 100 μL enzyme-linked detection antibody at 37° C. for 30 minutes, emptied and washed again, and incubated with 100 μL substrate at room temperature for 30 minutes. The provided quantitation standards are used as described by the manufacturer. Positive control reactions consist of diluent with NHS but without test compounds; negative control reactions consist of diluent only. After the 30 minute incubation, the A₄₀₅ of each well was recorded using a microplate spectrophotometer. TCC production was quantitated from A₄₀₅ by reference to the quantitation standards.

Combinatorial effect in both assays are analyzed using the three-dimensional surface-graphing method of Prichard, M. N. and C. Shipman, Jr., Antiviral Research 1990, 14: 181-205, wherein the X-axis and Y-axis indicate test compound concentrations and the Z-axis indicates the difference between measured inhibition and a theoretically determined additive inhibition. For an additive combinatorial relationship the surface graph will resemble a horizontal plane of zero height, whereas positive surface peaks indicate greater inhibition than expected and therefore synergy, and negative surface peaks indicate less inhibition than expected and therefore antagonism.

Combinatorial efficacy on the hemolysis of rabbit erythrocytes (RE) can be examined using a compound described herein and a wide variety of second active agents. For example, one non-limiting example was the peptidic complement C3 inhibitor compstatin (Tocris Bioscience). In another example, the combinatorial efficacy of a compound as described herein and a complement Factor B inhibitor can be assessed, for example, using the structure below (See compound 84 in WO2013/192345). Alternatively, the combinatorial efficacy of a compound of the present invention and a monoclonal antibody directed against complement C5 protein (anti-C5, Quidel A217, murine monoclonal antibody to human complement C5, isotype IgG1K) on the production of terminal complement complex (TCC) can be assessed. In another non-limiting example, the combinatorial efficacy of an active compound of the invention and the broad spectrum inhibitor FUT-175 (BD Biosciences) on the hemolysis of rabbit erythrocytes (RE) was assessed.

Structure of Complement Factor B Inhibitor

Synergy and antagonism volumes are the summed volumes of peaks respectively above and below the Z=0 plane on the surface graph. Volumes are determined using 95% confidence limits to assure significance. Compounds are considered additive for volumes between −25 and 25. Compounds are considered slightly synergistic for volumes between 25 and 50, moderately synergistic for volumes between 50 and 100, and strongly synergistic for volumes greater than 100. Compounds are considered slightly antagonistic for volumes between −25 and −50, moderately antagonistic for volumes between −50 and −100, and strongly antagonistic for volumes less than −100. Results are presented as means±standard deviations from two or three independent experiments.

This specification has been described with reference to embodiments of the invention. However, one of ordinary skill in the art appreciates that various modifications and changes can be made without departing from the scope of the invention as set forth in the claims below. Accordingly, the specification was to be regarded in an illustrative rather than a restrictive sense, and all such modifications are intended to be included within the scope of invention. 

We claim:
 1. A method for the treatment of a disorder mediated by complement factor D, comprising administering an effective amount to a host in need thereof a compound of the formula

or a pharmaceutically acceptable salt thereof, wherein: Q¹ is C(R¹R^(1′)); Q² is C(R²R^(2′)); Q³ is C(R³R^(3′)); X¹ is N and X² is CH; R¹, R^(1′), R², R^(2′), R³, and R^(3′) are independently chosen from hydrogen, halogen, hydroxyl, nitro, cyano, amino, C₁-C₆alkyl, C₂-C₆alkenyl, C₂-C₆alkynyl, C₁-C₆alkoxy, C₂-C₆alkanoyl, C₁-C₆thioalkyl, hydroxyC₁-C₆alkyl, aminoC₁-C₆alkyl, —C₀-C₄alkylNR⁹R¹⁰, —C(O)OR⁹, —OC(O)R⁹, —NR⁹C(O)R¹⁰, —C(O)NR⁹R¹⁰, —OC(O)NR⁹R¹⁰, —NR⁹C(O)OR¹⁰, C₁-C₂haloalkyl, and C₁-C₂haloalkoxy; R⁹ and R¹⁰ are independently chosen from hydrogen, C₁-C₆alkyl, (C₃-C₇cycloalkyl)C₀-C₄alkyl, and —C₀-C₄alkyl(C₃-C₇cycloalkyl), —O—C₀-C₄alkyl(C₃-C₇cycloalkyl); or R¹ and R² are linked to form a 3- to 6-membered carbocyclic or aryl ring; or R² and R³ are linked to form a 3- to 6-membered carbocyclic ring; or R¹ and R^(1′), R² and R^(2′) or R³ and R^(3′) are linked to form a 3- to 6-membered carbocyclic spiro ring; or R¹ and R^(1′), R² and R^(2′) or R³ and R^(3′) are linked to form a 3- to 6-membered heterocyclic spiro ring; each of which ring each of which ring may be unsubstituted or substituted with 1 or more substituents independently selected from halogen, hydroxyl, cyano, —COOH, C₁-C₄alkyl, C₂-C₄alkenyl, C₂-C₄alkynyl, C₁-C₄alkoxy, C₂-C₄alkanoyl, hydroxyC₁-C₄alkyl, (mono- and di-C₁-C₄alkylamino)C₀-C₄alkyl, —C₀-C₄alkyl(C₃-C₇cycloalkyl), —O—C₀-C₄alkyl(C₃-C₇cycloalkyl), C₁-C₂haloalkyl, and C₁-C₂haloalkoxy; or R¹ and R^(1′) or R² and R^(2′) are linked to form a carbonyl group; A is a group selected from:

R⁵ and R⁶ are independently selected from —CHO, —C(O)NH₂, —C(O)NH(CH₃), C₂-C₆alkanoyl, hydrogen, hydroxyl, halogen, cyano, nitro, —COOH, —SO₂NH₂, vinyl, C₁-C₆alkyl, C₂-C₆alkenyl, C₁-C₆alkoxy, —C₀-C₄alkyl(C₃-C₇cycloalkyl), —C(O)C₀-C₄alkyl(C₃-C₇cycloalkyl), —P(O)(OR⁹)₂, —OC(O)R⁹, —C(O)OR⁹, —C(O)N(CH₂CH₂R⁹)(R¹⁰), —NR⁹C(O)R¹⁰, phenyl, and 5- to 6-membered heteroaryl; R⁸ and R^(8′) are independently selected from hydrogen, halogen, hydroxyl, C₁-C₆alkyl, —C₀-C₄alkyl(C₃-C₇cycloalkyl), C₁-C₆alkoxy, and (C₁-C₄alkylamino)C₀-C₂alkyl; or R⁸ and R^(8′) are taken together to form an oxo group; or R⁸ and R^(8′) are taken together with the carbon that they are bonded to form a 3-membered carbocyclic ring; X¹¹ is N or CR¹¹; X¹² is N or CR¹²; X¹³ is N or CR¹³; X¹⁴ is N or CR¹⁴; wherein no more than 2 of X¹¹, X¹², X¹³, and X¹⁴ are N; one of R¹² and R¹³ is selected from R³¹ and the other of R¹² and R¹³ is selected from R³²; wherein when A is an indole or indazole and X¹² is N then X¹³ is CR³²; wherein when A is an indole or indazole and X¹³ is N then X¹² is CR³²; R³¹ is selected from hydrogen, halogen, hydroxyl, nitro, cyano, amino, —COOH, C₁-C₂haloalkyl, C₁-C₂haloalkoxy, C₁-C₆alkyl, —C₀-C₄alkyl(C₃-C₇cycloalkyl), C₂-C₆alkenyl, C₂-C₆alkanoyl, C₁-C₆alkoxy, C₂-C₆alkenyloxy, —C(O)OR⁹, C₁-C₆thioalkyl, —C₀-C₄alkylNR⁹R¹⁰, —C(O)NR⁹R¹⁰, —SO₂R⁹, —SO₂NR⁹R¹⁰, —OC(O)R⁹, and —C(NR⁹)NR⁹R¹⁰, each of which R³¹ other than hydrogen, halogen, hydroxyl, nitro, cyano, C₁-C₂haloalkyl, and C₁-C₂haloalkoxy is unsubstituted or substituted with one or more substituents independently selected from halogen, hydroxyl, nitro, cyano, amino, —COOH, —CONH₂ C₁-C₂haloalkyl, and C₁-C₂haloalkoxy, and each of which R³¹ is also optionally substituted with one substituent selected from phenyl and 4- to 7-membered heterocycle containing 1, 2, or 3 heteroatoms independently selected from N, O, and S; which phenyl or 4- to 7-membered heterocycle is unsubstituted or substituted with one or more substituents independently selected from halogen, hydroxyl, nitro, cyano, C₁-C₆alkyl, C₂-C₆alkenyl, C₂-C₆alkanoyl, C₁-C₆alkoxy, (mono- and di-C₁-C₆alkylamino)C₀-C₄alkyl, C₁-C₆alkylester, —C₀-C₄alkyl)(C₃-C₇cycloalkyl), C₁-C₂haloalkyl, and C₁-C₂haloalkoxy; R³² is —P(O)R²⁰R²⁰; R²⁰ is independently selected from hydroxyl, C₁-C₆alkoxy, C₁-C₆haloalkoxy, C₁-C₆alkyl, (C₃-C₇cycloalkyl)C₀-C₄alkyl-, (aryl)C₀-C₄alkyl-, —O—C₀-C₄alkyl(aryl), —O—C₀-C₄alkyl(C₃-C₇cycloalkyl), (4- to 7-membered heterocycloalkyl)C₀-C₄alkyl-O— having 1, 2, or 3 heteroatoms independently selected from N, O, and S; (5- or 6-membered unsaturated or aromatic heterocycle)C₀-C₄alkyl-O— having 1, 2, or 3 heteroatoms independently selected from N, O, and S; —O(CH₂)₂₋₄O(CH₂)₈₋₁₈, —OC(R^(20a))₂OC(O)OR^(20b), —OC(R^(20a))₂OC(O)R^(20b), —NR⁹R¹⁰, an N-linked amino acid and an N-linked amino acid ester and each R²⁰ is optionally substituted with a substituent selected from halogen, cyano, hydroxyl, alkanoyl, carboxamide, alkyl, cycloalkyl, alkenyl, alkynyl, alkoxy, aryloxy, alkylthio, alkylsulfinyl, alkylsulfonyl, aminoalkyl, arylalkyl and arylalkoxy; R^(20a) is independently selected at each occurrence from hydrogen, C₁-C₈alkyl, C₂-C₈alkenyl, C₂-C₈alkynyl, (aryl)C₀-C₄alkyl-, (aryl)C₂-C₈alkenyl- and (aryl)C₂-C₈alkynyl-; or two R^(20a) groups are taken together with the carbon that they are bonded to form a 3-6 membered heterocycloalkyl having 1, 2, or 3 heteroatoms independently selected from N, O, and S, or a 3-6 membered carbocyclic ring; R^(20b) is independently selected at each occurrence from C₁-C₈alkyl, C₂-C₈alkenyl, C₂-C₈alkynyl, (aryl)C₀-C₄alkyl, (aryl)C₂-C₈alkenyl and (aryl)C₂-C₈alkynyl; R¹¹ and R¹⁴ are independently selected from hydrogen, halogen, hydroxyl, nitro, cyano, —O(PO)(OR⁹)₂, —(PO)(OR⁹)₂, C₁-C₆alkyl, C₂-C₆alkenyl, C₂-C₆alkynyl, C₂-C₆alkenyl(aryl), C₂-C₆alkenyl(cycloalkyl), C₂-C₆alkenyl(heterocycle), C₂-C₆alkenyl(heteroaryl), C₂-C₆alkynyl, C₂-C₆alkynyl(aryl), C₂-C₆alkynyl(cycloalkyl), C₂-C₆alkynyl(heterocycle), C₂-C₆alkynyl(heteroaryl), C₂-C₆alkanoyl, C₁-C₆alkoxy, C₁-C₆thioalkyl, —C₀-C₄alkyl(mono- and di-C₁-C₆alkylamino), —C₀-C₄alkyl(C₃-C₇cycloalkyl), —C₀-C₄alkoxy(C₃-C₇cycloalkyl), C₁-C₂haloalkyl, and C₁-C₂haloalkoxy; R²¹ and R²² are independently selected at each occurrence from hydrogen, hydroxyl, cyano, amino, C₁-C₆alkyl, C₁-C₆haloalkyl, C₁-C₆alkoxy, (C₃-C₇cycloalkyl)C₀-C₄alkyl, (phenyl)C₀-C₄alkyl, —C₁-C₄alkylOC(O)OC₁-C₆alkyl, —C₁-C₄alkylOC(O)C₁-C₆alkyl, —C₁-C₄alkylC(O)OC₁-C₆alkyl, (4- to 7-membered heterocycloalkyl)C₀-C₄alkyl having 1, 2, or 3 heteroatoms independently selected from N, O, and S, and (5- or 6-membered unsaturated or aromatic heterocycle)C₀-C₄alkyl having 1, 2, or 3 heteroatoms independently selected from N, O, and S; R²³ is independently selected from (C₃-C₇cycloalkyl)C₀-C₄alkyl, (aryl)C₀-C₄alkyl, (4- to 7-membered heterocycloalkyl)C₀-C₄alkyl having 1, 2, or 3 heteroatoms independently selected from N, O, and S, and (5- or 6-membered unsaturated or aromatic heterocycle)C₀-C₄alkyl having 1, 2, or 3 heteroatoms independently selected from N, O, and S; R²⁴ and R²⁵ are taken together with the nitrogen to which they are attached to form a 4- to 7-membered monocyclic heterocycloalkyl group, or a 6- to 10-membered bicyclic heterocyclic group having fused, spiro, or bridged rings; L is selected from the formulas

R¹⁷ is hydrogen, C₁-C₆alkyl, or —C₀-C₄alkyl(C₃-C₇cycloalkyl); R¹⁸ and R^(18′) are independently selected from hydrogen, halogen, hydroxymethyl, and methyl; m is 0, 1, 2, or 3; B is —(C₀-C₄alkyl)(aryl); —(C₀-C₄alkyl)(heteroaryl); or —(C₀-C₄alkyl)(biphenyl), and B is unsubstituted or substituted with one or more substituents independently selected from R³³ and R³⁴, and 0 or 1 substituents selected from R³⁵ and R³⁶; R³³ is independently selected from halogen, hydroxyl, —COOH, cyano, C₁-C₆alkyl, C₂-C₆alkanoyl, C₁-C₆alkoxy, —C₀-C₄alkylNR⁹R¹⁰, —SO₂R⁹, C₁-C₂haloalkyl, and C₁-C₂haloalkoxy; R³⁴ is independently selected from nitro, C₂-C₆alkenyl, C₂-C₆alkynyl, C₁-C₆thioalkyl, -JC₃-C₇cycloalkyl, —B(OH)₂, -JC(O)NR⁹R²³, -JOSO₂OR²¹, —C(O)(CH₂)₁₋₄S(O)R²¹, —O(CH₂)₁₋₄S(O)NR²¹R²², -JOP(O)(OR²¹)(OR²²), -JP(O)(OR²¹)(OR²²), -JOP(O)(OR²¹)R²², -JP(O)(OR²¹)R²², -JOP(O)R²¹R²², -JP(O)R²¹R²², -JSP(O)(OR²)(OR²²), -JSP(O)(OR²¹)(R²²), -JSP(O)(R²¹)(R²²), -JNR⁹P(O)(NHR²¹)(NHR²²), -JNR⁹P(O)(OR²¹)(NHR²²), -JNR⁹P(O)(OR²¹)(OR²²), -JC(S)R²¹, -JNR²¹SO₂R²², -JNR⁹S(O)NR²¹R²², -JNR⁹SO₂NR¹⁰R²², -JSO₂NR⁹COR²², -JSO₂NR⁹CONR²¹R²², -JNR²¹SO₂R²², -JC(O)NR²¹SO₂R²², -JC(NH₂)NR²², -JC(NH₂)NR⁹S(O)₂R²², -JOC(O)NR²¹R²², -JNR²¹C(O)OR²², -JNR²¹OC(O)R²², —(CH₂)₁₋₄C(O)NR²¹R²², -JC(O)NR²⁴R²⁵, -JNR⁹C(O)R²¹, -JC(O)R²¹, -JNR⁹C(O)NR¹⁰R²², —CCR²¹, —(CH₂)₁₋₄OC(O)R²¹, and -JC(O)OR²³; each of which R³⁴ may be unsubstituted or substituted with one or more substituents independently selected from halogen, hydroxyl, nitro, cyano, amino, oxo, —B(OH)₂, —Si(CH₃)₃, —COOH, —CONH₂, —P(O)(OH)₂, C₁-C₆alkyl, —C₀-C₄alkyl(C₃-C₇cycloalkyl), C₁-C₆alkoxy, —C₀-C₂alkyl(mono- and di-C₁-C₄alkylamino), C₁-C₆alkylester, C₁-C₄alkylamino, C₁-C₄hydroxylalkyl, C₁-C₂haloalkyl, and C₁-C₂haloalkoxy; R³⁵ is independently selected from naphthyl, naphthyloxy, indanyl, (4- to 7-membered heterocycloalkyl)C₀-C₄alkyl containing 1 or 2 heteroatoms selected from N, O, and S, and bicyclic heterocycle containing 1, 2, or 3 heteroatoms independently selected from N, O, and S, and containing 4- to 7-ring atoms in each ring, each of which R³⁵ is unsubstituted or substituted with one or more substituents independently selected from halogen, hydroxyl, nitro, cyano, C₁-C₆alkyl, C₂-C₆alkenyl, C₂-C₆alkanoyl, C₁-C₆alkoxy, (mono- and di-C₁-C₆alkylamino)C₀-C₄alkyl, C₁-C₆alkylester, —C₀-C₄alkyl(C₃-C₇cycloalkyl), —SO₂R⁹, C₁-C₂haloalkyl, and C₁-C₂haloalkoxy; R³⁶ is independently selected from tetrazolyl, (phenyl)C₀-C₂alkyl, (phenyl)C₁-C₂alkoxy, phenoxy, and 5- or 6-membered heteroaryl containing 1, 2, or 3 heteroatoms independently selected from N, O, B, and S, each of which R³⁶ is unsubstituted or substituted with one or more substituents independently selected from halogen, hydroxyl, nitro, cyano, C₁-C₆alkyl, C₂-C₆alkenyl, C₂-C₆alkanoyl, C₁-C₆alkoxy, (mono- and di-C₁-C₆alkylamino)C₀-C₄alkyl, C₁-C₆alkylester, —C₀-C₄alkyl(C₃-C₇cycloalkyl), —SO₂R⁹, —OSi(CH₃)₂C(CH₃)₃, —Si(CH₃)₂C(CH₃)₃, C₁-C₂haloalkyl, and C₁-C₂haloalkoxy; and J is independently selected at each occurrence from a covalent bond, C₁-C₄alkylene, —OC₁-C₄alkylene, C₂-C₄alkenylene, and C₂-C₄alkynylene.
 2. The method of claim 1, wherein the host is a human.
 3. The method of claim 2, wherein the disorder is age-related macular degeneration (AMD) or retinal degeneration.
 4. The method of claim 2, wherein the disorder is multiple sclerosis, arthritis, or COPD.
 5. The method of claim 2, wherein the disorder is an ophthalmic disease.
 6. The method of claim 2, wherein the disorder is paroxysymal nocturnal hemoglobinuria (PNH).
 7. The method of claim 2, wherein the disorder is a respiratory disease.
 8. The method of claim 2, wherein the disorder is a cardiovascular disease.
 9. The method of claim 2, wherein the disorder is atypical or typical hemolytic uremic syndrome.
 10. The method of claim 2, wherein the disorder is rheumatoid arthritis.
 11. The method of claim 2, wherein the disorder is C3 glomerulonephritis.
 12. The method of claim 2, wherein the disorder is MPGN II.
 13. The method of claim 2, wherein the

ring is selected from:


14. The method of claim 2, wherein R²⁰ is independently chosen at each occurrence from hydroxyl, C₁-C₈alkoxy, C₁-C₆haloalkoxy, C₁-C₆alkyl, (C₃-C₇cycloalkyl)C₀-C₄alkyl-, (aryl)C₀-C₈alkyl-, —O—C₀-C₄alkyl(aryl), and —O—C₀-C₄alkyl(C₃-C₇cycloalkyl).
 15. The method of claim 2, wherein B is —(C₀-C₄alkyl)(aryl wherein B is unsubstituted or substituted with one or more substituents independently chosen from R³³ and R³⁴, and 0 or 1 substituents chosen from R³⁵ and R³⁶.
 16. The method of claim 2, wherein B is selected from:


17. The method of claim 2, wherein R³² is selected from:


18. The method of claim 2, wherein the compound is selected from:

or a pharmaceutically acceptable salt thereof.
 19. The method of claim 2, wherein the compound is of the formula:

or a pharmaceutically acceptable salt thereof.
 20. The method of claim 19, wherein: m is 1; B is 2-fluoro-3-chlorophenyl; one of R¹² and R¹³ is R³²; and R³² is P(O)R²⁰R²⁰.
 21. The method of claim 5, wherein the compound is administered to the intravitreal, subchoroidal, or suprachoroidal space of the eye.
 22. The method of claim 2, wherein the disorder is membrane proliferative glomerulonephritis.
 23. The method of claim 2, wherein the disorder is fatty liver.
 24. The method of claim 2, wherein the disorder is liver inflammation, cirrhosis, or liver failure.
 25. The method of claim 2, wherein the disorder is dermatomyositis.
 26. The method of claim 2, wherein the disorder is amyotrophic lateral sclerosis.
 27. The method of claim 2, wherein the disorder is nonalcoholic steatohepatitis (NASH).
 28. The method of claim 2, wherein the compound is administered in combination with an effective amount of an additional active agent. 